Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 24929 | MD |
NPI | 1003454125 |
---|---|
Provider Name | Jaclyn Bookman |
First Address | Silver Spring, MD 20910-4239 |
Second Address | Silver Spring, MD 20910-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2019 |
Last Update Date | 19/12/2019 |