| NPI | 1356454276 |
|---|---|
| Former Name | MARY ELLEN BOZAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 654) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 1866) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1866) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2016-12-20 |