Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 093484 | NY |
NPI | 1003213588 |
---|---|
Provider Name | Mr. Charles Whittington |
First Address | Brooklyn, NY 11201 |
Second Address | Brooklyn, NY 11201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2014 |
Last Update Date | 26/11/2014 |