Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C007456 | NC |
NPI | 1003197633 |
---|---|
Provider Name | Mrs. Maria Rivera |
First Address | Fayetteville, NC 28311-0208 |
Second Address | Fayetteville, NC 28311-2889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 13/01/2012 |