Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9720 | FL |
NPI | 1003228073 |
---|---|
Provider Name | Amanda Williams |
First Address | Gainesville, FL 32608-8719 |
Second Address | Gainesville, FL 32608-8719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 27/05/2014 |