Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05442800 | NJ |
NPI | 1003119033 |
---|---|
Provider Name | Carrie Rebecca Slater |
First Address | Cherry Hill, NJ 08034-2114 |
Second Address | Cherry Hill, NJ 08034-2114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2010 |
Last Update Date | 14/12/2010 |