Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R053486-1 | NY |
NPI | 1003021551 |
---|---|
Provider Name | Jocelyn Reeve Childs |
First Address | New York, NY 10028-1066 |
Second Address | New York, NY 10023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |