| NPI | 1164544516 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT #863) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: VT #863) |
| 103TH0004X Psychologist, Health (Licence: VT #863) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2007-07-08 |