Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW5253 | FL |
NPI | 1003186842 |
---|---|
Provider Name | Cynthia Dalton |
First Address | Boynton Beach, FL 33436-4637 |
Second Address | Boynton Beach, FL 33436-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |