Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW5867 | FL |
NPI | 1003012469 |
---|---|
Provider Name | Mr. Christopher Simmons |
First Address | Land O Lakes, FL 34638 |
Second Address | Land O Lakes, FL 34638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |