Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CA |
NPI | 1003120379 |
---|---|
Provider Name | Mrs. Minata Barnette |
First Address | Los Angeles, CA 90012-4112 |
Second Address | Los Angeles, CA 90017-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2010 |
Last Update Date | 16/06/2020 |