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Individual
DORA TIN
Active
Individual
DORA TIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
116672
NY
1041C0700X
Clinical Social Worker
Primary
C012262
NC
1041C0700X
Clinical Social Worker
CW020897
PA
1041C0700X
Clinical Social Worker
I.2002074
OH
Other
Enumeration date
06/19/2017
Last updated
06/16/2024
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