Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL06740000 | NJ |
NPI | 1003575549 |
---|---|
Provider Name | Ms. Kayleigh Shaw |
First Address | Sparta, NJ 07871-3616 |
Second Address | Sparta, NJ 07871-3616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |