Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 00082423 | NY |
NPI | 1003109638 |
---|---|
Provider Name | Audrey Sheridan |
First Address | New York, NY 10029 |
Second Address | New York, NY 10029-7407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 20/04/2012 |