Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 006735 | CT |
NPI | 1003072471 |
---|---|
Provider Name | Michael Powers |
First Address | Manchester, CT 06040-5242 |
Second Address | Manchester, CT 06040-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 29/03/2011 |