Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 14005 | MD |
NPI | 1003179375 |
---|---|
Provider Name | Miss Heather Gould Kerr |
First Address | Havre De Grace, MD 21078 |
Second Address | Havre De Grace, MD 21078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 09/10/2019 |