Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 073722-1 | NY |
N | 1041C0700X | Clinical Social Worker | 079090 | NY |
NPI | 1003118027 |
---|---|
Provider Name | Mr. James Mayer |
First Address | Glen Head, NY 11545-1947 |
Second Address | Glen Head, NY 11545-1947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2010 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03003069 | (05) | NY |