Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003239039 |
---|---|
Provider Name | Maria Roush |
First Address | El Dorado Hills, CA 95762-4202 |
Second Address | El Dorado Hills, CA 95762-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 27/01/2014 |