Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 105140 | TX |
NPI | 1003489196 |
---|---|
Provider Name | Tyler Fishbein |
First Address | San Antonio, TX 78209-1761 |
Second Address | San Antonio, TX 78209-1761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |