| NPI | 1104240167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 219497) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 219497) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2015-10-13 |