| NPI | 1295139251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MANASSERI Psychologist 302-478-1578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0001005) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS017616) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017616) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: PA PS017616) | |
| 103G00000X Clinical Neuropsychologist (Licence: DE B1-0001005) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: DE B1-0001005) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2015-02-13 |