Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 082118-1 | NY |
Y | 1041C0700X | Clinical Social Worker | 84730 | NY |
NPI | 1003323593 |
---|---|
Provider Name | Julie Lynn Lawless |
First Address | Madrid, NY 13660-3189 |
Second Address | Potsdam, NY 13676-1786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2018 |
Last Update Date | 03/10/2019 |