Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 080029-1 | NY |
NPI | 1003173428 |
---|---|
Provider Name | Mrs. Linda Sue Gruman |
First Address | Woodmere, NY 11598-1205 |
Second Address | Woodmere, NY 11598-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 25/04/2013 |