Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801089286 | MI |
NPI | 1003001819 |
---|---|
Provider Name | Sara M Tavora |
First Address | Port Huron, MI 48060-3838 |
Second Address | Port Huron, MI 48060-3838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 17/09/2019 |