NPI | 1962087940 |
---|---|
Former Name | MARIAH ELAINE FRITCHEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SC 13575) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2019022942) |
1041C0700X Social Worker Clinical (Licence: WY 1199) | |
Enumeration Date | 2021-03-11 |
Last Update Date | 2021-03-11 |