Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 114681 | NY |
NPI | 1003567025 |
---|---|
Provider Name | Jessica Panagiotidis |
First Address | E Northport, NY 11731-0475 |
Second Address | Hauppauge, NY 11788-4358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |