Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003323296 |
---|---|
Provider Name | Mauria Shermane Tomlin |
First Address | Saint Louis, MO 63103-2303 |
Second Address | Bridgeton, MO 63044-2550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 09/01/2018 |