Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 5083 | KY |
N | 1041C0700X | Clinical Social Worker |
NPI | 1003245465 |
---|---|
Provider Name | Miss Dara M Concepcion-Perry |
First Address | Cincinnati, OH 45202-1457 |
Second Address | Crestview Hills, KY 41017-5130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100389490 | (05) | KY |