| NPI | 1174710669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9176) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 017233-1) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2012-01-18 |