| NPI | 1063265403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA PSY10002328) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS02454) |
| 101YM0800X Counselor, Mental Health (Licence: NE 13927) | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2026-09-23 |