| NPI | 1093871188 |
|---|---|
| Former Name | SUSAN ELIZABETH BROADWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC PSY2859) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC PSY2859) |
| 103T00000X Psychologist (Licence: NC PSY2859) | |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2022-03-28 |