Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 09629 | MD |
NPI | 1992973994 |
---|---|
Provider Name | Ms. Diane Tuttle Ursano |
First Address | Kensington, MD 20895-3804 |
Second Address | Kensington, MD 20895-3804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2008 |
Last Update Date | 13/02/2008 |