NPI | 1154726412 |
---|---|
Former Name | COURTNEY LYNN BENJAMIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017590) |
Enumeration Date | 2014-10-29 |
Last Update Date | 2014-10-29 |