Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003212978 |
---|---|
Provider Name | Victoria Reiszner |
First Address | Lowell, MA 01851-1731 |
Second Address | Lowell, MA 01851-1731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 05/11/2014 |