Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 111365 | NY |
NPI | 1003489741 |
---|---|
Provider Name | Tory Thomas |
First Address | Brooklyn, NY 11234-1746 |
Second Address | Brooklyn, NY 11234-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2021 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111365 | LICENSE NUMBER (01) | NY |