Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05568100 | NJ |
NPI | 1003232059 |
---|---|
Provider Name | Kathy Elias |
First Address | Union City, NJ 07087-3305 |
Second Address | Union City, NJ 07087-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2014 |
Last Update Date | 14/03/2014 |