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Individual

Inactive
Sole proprietor

Provider details

NPI number

Contact information

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
054540-1
NY
1041S0200X
School Social Worker
054540-1
NY
225X00000X
Occupational Therapist
003430-1
NY
225XP0200X
Pediatric Occupational Therapist
Primary
003430-1
NY

Other

Enumeration date
Last updated
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