Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 108769-01 | NY |
NPI | 1003306275 |
---|---|
Provider Name | Asiya Vickers |
First Address | New York, NY 10016-8334 |
Second Address | Brooklyn, NY 11209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 15/01/2020 |