| 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 |