| NPI | 1063792190 |
|---|---|
| Former Name | BETHANY SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 019234) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 019234) |
| 103TS0200X Psychologist School (Licence: NY 019234) | |
| Enumeration Date | 2011-08-21 |
| Last Update Date | 2012-04-11 |