Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S.0600183 | OH |
NPI | 1003022302 |
---|---|
Provider Name | Carrie Haverkos |
First Address | Urbana, OH 43078-1114 |
Second Address | Urbana, OH 43078-2289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |