Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | MC14217 | ME |
NPI | 1003257403 |
---|---|
Provider Name | Mr. Dustin Bernard Przybylski |
First Address | Brewer, ME 04412-2035 |
Second Address | Brewer, ME 04412-2035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2013 |
Last Update Date | 13/07/2013 |