Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 149.015513 | IL |
NPI | 1003179292 |
---|---|
Provider Name | Mrs. Eliverta Barjamaj |
First Address | Chicago, IL 60612-4300 |
Second Address | Chicago, IL 60612-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 15/10/2012 |