| NPI | 1447434709 |
|---|---|
| Former Name | MARITZA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist (Licence: NY 2030100) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2023-03-07 |