Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003487539 |
---|---|
Provider Name | Elvin June Cardona |
First Address | Roslindale, MA 02131-2650 |
Second Address | Roslindale, MA 02131-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |