Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL06408400 | NJ |
NPI | 1003390485 |
---|---|
Provider Name | Vincent Maixner |
First Address | Charleston, SC 29401-5703 |
Second Address | Charleston, SC 29401-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 14/12/2018 |