Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003368754 |
---|---|
Provider Name | Jamarco Thomas |
First Address | Mchenry, IL 60050-1836 |
Second Address | Mchenry, IL 60050-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2016 |
Last Update Date | 28/10/2016 |