Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 9064 | FL |
NPI | 1134259757 |
---|---|
Provider Name | Sarah Dew-Reeves |
First Address | Jacksonville, FL 32223-8621 |
Second Address | Jacksonville, FL 32223-8621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 21/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003173103A | (05) | GA |
012844400 | (05) | FL |