Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 3913 | KY |
NPI | 1003118795 |
---|---|
Provider Name | Constance Morris |
First Address | Covington, KY 41011-3717 |
Second Address | Florence, KY 41042-1553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2010 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
610661458 | GROUP TAX ID (01) | KY |