Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW 12219 | FL |
NPI | 1003170283 |
---|---|
Provider Name | Sasha J Thompson |
First Address | Tampa, FL 33609-1632 |
Second Address | Tampa, FL 33609-1632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2012 |
Last Update Date | 27/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013496600 | (05) | FL |