Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 34000336A | IN |
NPI | 1003198698 |
---|---|
Provider Name | Ashvin O Sheth |
First Address | Portage, IN 46368-4562 |
Second Address | Portage, IN 46368-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 09/09/2011 |