Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003110867 |
---|---|
Provider Name | Katie Wynen |
First Address | Brighton, MA 02135-3601 |
Second Address | Brighton, MA 02135-3601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 07/01/2011 |