Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 21503 | MD |
NPI | 1003380643 |
---|---|
Provider Name | Kaitlan Phillips |
First Address | Rising Sun, MD 21911-1545 |
Second Address | Rising Sun, MD 21911-1545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2019 |
Last Update Date | 16/01/2019 |