Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 220165 | MA |
NPI | 1003219866 |
---|---|
Provider Name | Ellen Mary Snead |
First Address | Dedham, MA 02026-4123 |
Second Address | Dedham, MA 02026-4123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 07/10/2014 |