Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 103866 | MA |
NPI | 1003032830 |
---|---|
Provider Name | Ms. Em Kessler |
First Address | Jamaica Plain, MA 02130-1650 |
Second Address | Jamaica Plain, MA 02130-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1303414 | (05) | MA |