| NPI | 1073665410 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000917) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-03-16 |