| NPI | 1114455516 |
|---|---|
| Former Name | KELLY SUZANNE WOLF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10605) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 3525) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2018-12-18 |