| NPI | 1407273352 |
|---|---|
| Former Name | KRYSTIE MARIE DECICCO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007045) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007045-1) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2018-09-03 |