Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW7817 | FL |
NPI | 1003027970 |
---|---|
Provider Name | Mr. Ted Williams |
First Address | Fort Lauderdale, FL 33334-1506 |
Second Address | Fort Lauderdale, FL 33334-1506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 09/07/2007 |