Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 25711 | MD |
Y | 104100000X | Social Worker | LG50082914 | DC |
NPI | 1003498817 |
---|---|
Provider Name | Miraf Kebede SR. |
First Address | Silver Spring, MD 20910-6275 |
Second Address | Washington, DC 20019-3565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2021 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46905567200 | (05) | MD |