| NPI | 1164693438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 017556) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 017556) |
| 103TR0400X Psychologist Rehabilitation (Licence: NY 017556) | |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |