| NPI | 1023408903 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2021-09-02 |