| NPI | 1073605614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 016634) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 2951) |
| 103TC0700X Psychologist Clinical (Licence: MO 2011000658) | |
| 103TC0700X Psychologist Clinical (Licence: IA 001285) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2015-04-20 |