Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05895300 | NJ |
NPI | 1992300289 |
---|---|
Provider Name | Dori Legrand-Christmas |
First Address | Montclair, NJ 07043-2327 |
Second Address | Montclair, NJ 07043-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 26/02/2021 |