| NPI | 1053515361 |
|---|---|
| Former Name | PAMELA LONGFELLOW BLUME |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003789) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC 1000392) |
| 103TC0700X Psychologist Clinical (Licence: HI 962) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-07-08 |