Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003216961 |
---|---|
Provider Name | Brian Adderley |
First Address | Altamonte Springs, FL 32714-5206 |
Second Address | Altamonte Springs, FL 32714-5206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2014 |
Last Update Date | 28/08/2014 |