Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I.0900238 | OH |
NPI | 1003140286 |
---|---|
Provider Name | Mr. Dale James Smith |
First Address | Columbus, OH 43201-2460 |
Second Address | Columbus, OH 43201-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 22/09/2009 |