Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ISW8255 | FL |
NPI | 1003230004 |
---|---|
Provider Name | Ms. Jamie Lee Green |
First Address | Tamarac, FL 33351-4325 |
Second Address | Tamarac, FL 33351-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2014 |
Last Update Date | 11/02/2014 |