| NPI | 1124091046 |
|---|---|
| Former Name | MIA RENEE PETERITAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17853) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW014749) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2012-05-07 |