Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 076795-1 | NY |
N | 1041S0200X | School Social Worker | 649550 | NY |
NPI | 1003135609 |
---|---|
Provider Name | Miss Valene Vanessa Valerie |
First Address | Brooklyn, NY 11210-0951 |
Second Address | Brooklyn, NY 11210-2332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2010 |
Last Update Date | 20/05/2010 |