Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 1041C0700X | Clinical Social Worker |
NPI | 1003232216 |
---|---|
Provider Name | Emily Jones |
First Address | Casselberry, FL 32707-9063 |
Second Address | Orlando, FL 32817-4139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 21/07/2020 |