Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 074231 | NY |
NPI | 1003029216 |
---|---|
Provider Name | Mr. David Joseph Mckeon |
First Address | Gloversville, NY 12078 |
Second Address | Gloversville, NY 12078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 18/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02994425 | (05) | NY |