Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003390360 |
---|---|
Provider Name | Brian Jukins |
First Address | Burlington, MA 01803-5108 |
Second Address | Burlington, MA 01803-5108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 21/08/2020 |