| NPI | 1194792226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4250) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 4250) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 4250) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2016-04-01 |