Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 000656 | TN |
NPI | 1003825647 |
---|---|
Provider Name | Ms. Karen Mason Riss |
First Address | Memphis, TN 38104 |
Second Address | Memphis, TN 38104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |