Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ISW4397 | FL |
NPI | 1003056946 |
---|---|
Provider Name | Vicki Mary Wotring |
First Address | Longwood, FL 32779-3105 |
Second Address | Longwood, FL 32750-6166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ISW4397 | SOCIAL WORKER (01) | FM |