Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL05828600 | NJ |
NPI | 1003451857 |
---|---|
Provider Name | Alexandra Smith |
First Address | Rumson, NJ 07760-0495 |
Second Address | Matawan, NJ 07747-3104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |