| NPI | 1215971536 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004561) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 016141) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-10-15 |