Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R-025826 | NY |
NPI | 1003071911 |
---|---|
Provider Name | Mrs. Hollace Merrill Beer |
First Address | Staten Island, NY 10314-4908 |
Second Address | Staten Island, NY 10314-4908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |