Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 12743 | TX |
NPI | 1003017914 |
---|---|
Provider Name | Ms. Kathleen P Fallon |
First Address | Sugar Land, TX 77479-3811 |
Second Address | Houston, TX 77081-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |