Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 20000700 | CA |
NPI | 1003343625 |
---|---|
Provider Name | Ms. Maureen Isabella Carter |
First Address | Rohnert Park, CA 94928-1446 |
Second Address | Rohnert Park, CA 94928-1446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |