| NPI | 1124381173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: NY 745222971) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 745222971) |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2023-07-19 |