Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003059007 |
---|---|
Provider Name | Mrs. Dana Leslie Foote |
First Address | Riviera Beach, FL 33404-5003 |
Second Address | Riviera Beach, FL 33404-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2009 |
Last Update Date | 07/04/2009 |