Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 061608-1 | NY |
NPI | 1003053273 |
---|---|
Provider Name | Ms. Sharon Rose Wade |
First Address | Bronx, NY 10457-6305 |
Second Address | Bronx, NY 10457-6305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2009 |
Last Update Date | 12/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1881733830 | (05) | NY |