Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 083516 | NY |
NPI | 1003242421 |
---|---|
Provider Name | Shannon Cruz-Herr |
First Address | Brooklyn, NY 11217-3952 |
Second Address | New York, NY 10023-7603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 03/12/2018 |