Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003235466 |
---|---|
Provider Name | Mary Kruszka |
First Address | Buffalo, NY 14225-1950 |
Second Address | Hamburg, NY 14075-4905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 14/04/2014 |