Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | PA |
NPI | 1003027715 |
---|---|
Provider Name | Mary Jane Smith |
First Address | Reading, PA 19601-3504 |
Second Address | Reading, PA 19601-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 28/08/2015 |