Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | MC14433 | ME |
NPI | 1003216904 |
---|---|
Provider Name | Ms. Elizabeth Anne Karlonas |
First Address | Biddeford, ME 04005 |
Second Address | Portland, ME 04101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2014 |
Last Update Date | 27/08/2014 |