| NPI | 1164418638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 463) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SD 1730) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2015-02-05 |