| NPI | 1003267964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11626) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 11626) |
| 103TC1900X Psychologist, Counseling (Licence: MA 11626) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 11626) | |
| 103TF0000X Psychologist, Family (Licence: MA 11626) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-01-31 |