Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL06593900 | NJ |
NPI | 1003405796 |
---|---|
Provider Name | Marissa Geist |
First Address | Westfield, NJ 07090-2147 |
Second Address | Westfield, NJ 07090-2147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2021 |
Last Update Date | 16/01/2021 |