Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 34008126A | IN |
NPI | 1003369273 |
---|---|
Provider Name | Nicholas Todoran |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46805-4749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 13/12/2018 |