| NPI | 1245368992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2299804) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7316) |
| 101YP2500X Counselor, Professional (Licence: MA 2042) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-02-22 |