| NPI | 1114979721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 8463) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MA 8463) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MA 8463) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MA 8463) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2011-02-09 |