Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003283680 |
---|---|
Provider Name | Miss Rachel Novak |
First Address | Hartford, CT 06105-1901 |
Second Address | Hartford, CT 06105-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2015 |
Last Update Date | 30/08/2015 |