| NPI | 1124336920 |
|---|---|
| Former Name | MARYELLEN FAIRCHILD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121357) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 81865) |
| 225A00000X Music Therapist (Licence: PA 09139) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-05-28 |