| NPI | 1376930503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 552955) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 552955) |
| 222Q00000X Developmental Therapist (Licence: NJ 552955) | |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2016-06-23 |