Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ISW5490 | FL |
N | 1041C0700X | Clinical Social Worker | ISW5490 | FL |
NPI | 1003457904 |
---|---|
Provider Name | Jamie A Udeh |
First Address | Manchester, CT 06042-4200 |
Second Address | West Hartford, CT 06107-2187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2019 |
Last Update Date | 01/10/2019 |