| NPI | 1093220865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.019876) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149.019876) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 149.019876) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IL 149.019876) | |
| Enumeration Date | 2017-12-02 |
| Last Update Date | 2017-12-02 |