Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ISW3031 | FL |
NPI | 1003148792 |
---|---|
Provider Name | Ms. Clarissia Brown |
First Address | Tampa, FL 33612-8667 |
Second Address | Tampa, FL 33612-8667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2010 |
Last Update Date | 04/02/2010 |