Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | M-05692 | NM |
NPI | 1003091281 |
---|---|
Provider Name | Mr. Terry Scott Sine |
First Address | Santa Fe, NM 87505 |
Second Address | Santa Fe, NM 87505-7614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78558 | (05) | NM |