Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 0713451 | NY |
Y | 1041C0700X | Clinical Social Worker | 076886-1 | NY |
NPI | 1003081795 |
---|---|
Provider Name | Ms. Tara Chivukula |
First Address | New York, NY 10010-2945 |
Second Address | New York, NY 10010-2945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 29/10/2009 |