| NPI | 1285999268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 020747) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 9704) |
| 174400000X Specialist (Licence: NY P91196) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2015-09-17 |