Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003488941 |
---|---|
Provider Name | Kim Dwyer |
First Address | Philadelphia, PA 19146-1415 |
Second Address | Philadelphia, PA 19146-1415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |