NPI | 1205168861 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: MA 9892) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 9892) |
Enumeration Date | 2010-02-08 |
Last Update Date | 2015-05-21 |