Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44L06081600 | NJ |
NPI | 1003263526 |
---|---|
Provider Name | Glenn Parker |
First Address | Toms River, NJ 08753-7414 |
Second Address | Toms River, NJ 08753-7414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 16/05/2016 |