Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003411513 |
---|---|
Provider Name | Lisette Nunez Berman |
First Address | Indianapolis, IN 46250-1953 |
Second Address | Indianapolis, IN 46250-1953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |