Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904005007 | VA |
NPI | 1003034125 |
---|---|
Provider Name | Mr. J. Patrick Slifka |
First Address | Midlothian, VA 23112 |
Second Address | Richmond, VA 23230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |