Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003443219 |
---|---|
Provider Name | D'amira Kendrick |
First Address | Bridgeport, CT 06606-4730 |
Second Address | New Haven, CT 06519-1233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |