Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 09106 | MD |
NPI | 1003131772 |
---|---|
Provider Name | Stacey Lee Hamro |
First Address | Columbia, MD 21046-1310 |
Second Address | Columbia, MD 21046-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2010 |
Last Update Date | 06/04/2010 |