Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003214438 |
---|---|
Provider Name | Steve Wilkins |
First Address | Boston, MA 02120-2149 |
Second Address | Boston, MA 02120-2149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2014 |
Last Update Date | 17/12/2014 |