Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | RO48508-1 | NY |
NPI | 1003054271 |
---|---|
Provider Name | Mr. Gustavo Anibal Checa |
First Address | New York, NY 10032-3512 |
Second Address | New York, NY 10032-3512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 27/01/2009 |