Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 10780 | DE |
NPI | 1043354772 |
---|---|
Provider Name | Judith Green |
First Address | Odessa, DE 19730 |
Second Address | Odessa, DE 19730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |