| NPI | 1376751297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 6405) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 6405) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 6405) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-09 |