| NPI | 1083169791 |
|---|---|
| Other Name | IVY BURGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.010821) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.013118) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2023-05-31 |