| NPI | 1154792158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 8270) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 8270) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 8270) | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2015-10-15 |