Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 108859-01 | PA |
Y | 104100000X | Social Worker | SW137550 | NY |
NPI | 1003575143 |
---|---|
Provider Name | Brittany Gozikowski |
First Address | Middle Village, NY 11379-1137 |
Second Address | Middle Village, NY 11379-1137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2021 |
Last Update Date | 16/12/2021 |