Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW11210 | FL |
NPI | 1003155920 |
---|---|
Provider Name | Jill Rae Brewer |
First Address | Estero, FL 34135-8488 |
Second Address | Estero, FL 34135-8488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 10/08/2016 |