Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC04750100 | NJ |
NPI | 1992949937 |
---|---|
Provider Name | Mrs. Joanna Maxine D'agosta |
First Address | Landing, NJ 07850-1728 |
Second Address | Sparta, NJ 07871-1120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 14/12/2016 |