Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | FL |
NPI | 1003222019 |
---|---|
Provider Name | Heidi Cantrell |
First Address | New Port Richey, FL 34654-5567 |
Second Address | New Port Richey, FL 34654-5567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 10/07/2014 |