NPI | 1033368659 |
---|---|
Former Name | SARA R CORBIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 2005) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2011031728) |
Enumeration Date | 2008-09-18 |
Last Update Date | 2014-12-09 |