NPI | 1487679148 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100354300) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012338-1) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35S100354300) | |
103T00000X Psychologist (Licence: NJ 35S100354300) | |
Enumeration Date | 2006-07-13 |
Last Update Date | 2007-07-08 |