Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | FL |
NPI | 1003164138 |
---|---|
Provider Name | Ms. Montez Willa Thomasson |
First Address | Fort Lauderdale, FL 33309-7122 |
Second Address | Fort Lauderdale, FL 33309-7122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |