Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R053343-1 | NY |
NPI | 1003246281 |
---|---|
Provider Name | Jennifer Nola |
First Address | Mill Neck, NY 11765-1102 |
Second Address | Mill Neck, NY 11765-1102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |