Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 113388 | MA |
NPI | 1003199613 |
---|---|
Provider Name | Amy Sturm |
First Address | Danvers, MA 01923-4000 |
Second Address | Danvers, MA 01923-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 21/09/2011 |