Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW2882 | FL |
NPI | 1003053927 |
---|---|
Provider Name | Ms. Ida Marlene Pharr |
First Address | Fort Pierce, FL 34951-1514 |
Second Address | Fort Pierce, FL 34951-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 14/01/2009 |