Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 104143 | MA |
NPI | 1003085432 |
---|---|
Provider Name | Ms. Nia-Sue Mitchum |
First Address | Roxbury, MA 02119-2201 |
Second Address | Roxbury, MA 02119-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 13/03/2008 |