Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904005353 | VA |
NPI | 1003219882 |
---|---|
Provider Name | Kristi Difilippo |
First Address | Richmond, VA 23238-4453 |
Second Address | Richmond, VA 23238-4453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 07/10/2014 |