Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003462128 |
---|---|
Provider Name | Rebecca Tyberg |
First Address | Brooklyn, NY 11213-2690 |
Second Address | Brooklyn, NY 11213-2690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |