Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1003210923 |
---|---|
Provider Name | Olivia Loveria |
First Address | Las Vegas, NV 89119-7315 |
Second Address | Brockport, NY 14420-2997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2014 |
Last Update Date | 21/10/2014 |