| NPI | 1457574204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 001318) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 001318) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CT 001318) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CT 001318) | |
| 103TF0000X Psychologist Family (Licence: CT 001318) | |
| 103TH0004X Psychologist Health (Licence: CT 001318) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-11-10 |