Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 074105-1 | NY |
NPI | 1003070665 |
---|---|
Provider Name | Matti Ilmari Kala |
First Address | Forest Hills, NY 11375-4656 |
Second Address | Queens Village, NY 11428-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 14/07/2008 |