Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL05615300 | NJ |
NPI | 1003132606 |
---|---|
Provider Name | Katie Jo Hommes |
First Address | Prospect Park, NJ 07508-1939 |
Second Address | Fair Lawn, NJ 07410-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 08/04/2010 |