Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 118382 | MA |
NPI | 1003397969 |
---|---|
Provider Name | Mrs. Jennifer Mae Marcus |
First Address | West Springfield, MA 01089-1669 |
Second Address | West Springfield, MA 01089-1669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 28/08/2018 |