Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 10133 | CT |
NPI | 1003288820 |
---|---|
Provider Name | Kiley J Young |
First Address | Waterford, CT 06385-2401 |
Second Address | Waterford, CT 06385-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 14/09/2019 |