Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 104100000X | Social Worker | 107470 | NY |
NPI | 1003388646 |
---|---|
Provider Name | Amanda Kaju |
First Address | Forest Hills, NY 11375-7200 |
Second Address | Forest Hills, NY 11375-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 24/01/2021 |