Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW7868 | ZZ |
NPI | 1003140245 |
---|---|
Provider Name | Octavia Seals |
First Address | Pensacola, FL 32501-1857 |
Second Address | Pensacola, FL 32501-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
766591100 | (05) | FL |