NPI | 1366525784 |
---|---|
Former Name | ANNE MARIE WIDEMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04548) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 3258) |
Enumeration Date | 2006-10-21 |
Last Update Date | 2011-12-13 |