| NPI | 1295054195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 9952) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 8354) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-04-18 |