Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 28071 | MD |
NPI | 1003574229 |
---|---|
Provider Name | Jacqueline Mitchell |
First Address | Frederick, MD 21701-5846 |
Second Address | Frederick, MD 21701-5846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2021 |
Last Update Date | 05/12/2021 |