Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | Q1-0001009 | DE |
NPI | 1003104902 |
---|---|
Provider Name | Luz Del Alba Reynoso |
First Address | Newark, DE 19713 |
Second Address | Newark, DE 19713-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 17/03/2018 |