Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 094955 | NY |
NPI | 1003282476 |
---|---|
Provider Name | Ms. Christine Michelle Boutin |
First Address | Queens Village, NY 11428-1526 |
Second Address | New York, NY 10001-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 19/08/2015 |