Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 108413-01 | NY |
NPI | 1003455171 |
---|---|
Provider Name | Karizma Jazmon Funnye |
First Address | Spring Valley, NY 10977-3302 |
Second Address | Spring Valley, NY 10977-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 06/01/2020 |