| NPI | 1457076804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 025574) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025574) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2023-09-18 |