Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 106712-01 | NY |
NPI | 1003467390 |
---|---|
Provider Name | Chad Mcdonald |
First Address | Rochester, NY 14607-4039 |
Second Address | Rochester, NY 14607-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2019 |
Last Update Date | 27/09/2019 |