Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 110181 | NY |
NPI | 1003499583 |
---|---|
Provider Name | Shannon Blanch |
First Address | Katonah, NY 10536-3617 |
Second Address | Katonah, NY 10536-3617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |