Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 107759-01 | NY |
NPI | 1003458464 |
---|---|
Provider Name | Georgia Loughlin |
First Address | Bronx, NY 10463-6451 |
Second Address | Bronx, NY 10463-6451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2019 |
Last Update Date | 16/10/2019 |