Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 103604 | NY |
NPI | 1003468869 |
---|---|
Provider Name | Odessia Nicole Brown |
First Address | New York, NY 10029-2135 |
Second Address | Bronx, NY 10470-1407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 10/03/2021 |