Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003060724 |
---|---|
Provider Name | Ms. Joanna Imse |
First Address | Needham, MA 02494-1360 |
Second Address | Needham, MA 02494-1360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2008 |
Last Update Date | 13/05/2013 |