| NPI | 1184620650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS005426L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS005426L) |
| 103TF0000X Psychologist Family (Licence: PA PS005426L) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2007-07-08 |