| NPI | 1104266154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9723) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 020137) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2015-07-28 |