Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CW017276 | PA |
NPI | 1003167875 |
---|---|
Provider Name | Ms. Robyn Allen Smith |
First Address | Philadelphia, PA 19102-3403 |
Second Address | Philadelphia, PA 19102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 25/11/2019 |