| NPI | 1043229842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: MA 6289) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 6289) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 6289) | |
| 103TF0000X Psychologist, Family | |
| 103TH0100X Psychologist, Health Service | |
| 103T00000X Psychologist (Licence: MA 6289) | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103T00000X Psychologist | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-05-21 |