| NPI | 1477646529 |
|---|---|
| Former Name | ELIZABETH ANN FAGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI mch00199) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI mhc00199) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-01-23 |