| NPI | 1407904543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 6858) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 6858) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MA 116459) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-12-01 |