Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003191016 |
---|---|
Provider Name | Tonya Mustipher |
First Address | Staten Island, NY 10314-5866 |
Second Address | Staten Island, NY 10314-5866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2011 |
Last Update Date | 21/10/2011 |