Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC50078982 | DC |
NPI | 1003115148 |
---|---|
Provider Name | Ms. Maura A Healy |
First Address | Washington, DC 20001-4113 |
Second Address | Washington, DC 20001-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 15/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X645 | BCBS (01) | DC |