Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 0814761 | NY |
NPI | 1003121443 |
---|---|
Provider Name | Ms. Maria W Sutrisno |
First Address | Brooklyn, NY 11209-2942 |
Second Address | Brooklyn, NY 11201-5861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 10/08/2010 |