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Individual
SHONNA JOLENE BRODHEAD
Active
Individual
SHONNA JOLENE BRODHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
091721-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
091721-1
STATE LICENSE
NY
Enumeration date
09/08/2017
Last updated
09/08/2017
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