Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | RO58795-1 | NY |
NPI | 1003043407 |
---|---|
Provider Name | Elizabeth Lebron |
First Address | Corona, NY 11368-2647 |
Second Address | Corona, NY 11368-2647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 12/06/2009 |