Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 107402 | NY |
NPI | 1003422049 |
---|---|
Provider Name | Tara Lee Smith |
First Address | New York, NY 10029-2670 |
Second Address | New York, NY 10065-7769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2020 |
Last Update Date | 16/09/2020 |