Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CW019112 | PA |
NPI | 1003043266 |
---|---|
Provider Name | Jessica Beatty |
First Address | Larimer, PA 15647-9704 |
Second Address | Larimer, PA 15647-9704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 24/05/2019 |