NPI | 1114310117 |
---|---|
Former Name | DANA LEIGH SMIDT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4904) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021009) |
Enumeration Date | 2015-03-15 |
Last Update Date | 2015-06-23 |