| NPI | 1255639910 |
|---|---|
| Former Name | JENNIFER MARIE LANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01130) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: RI PS01130) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2011-03-04 |