| NPI | 1538731039 |
|---|---|
| Former Name | ALEXANDRA REVELES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3394) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 3394) |
| 103TC1900X Psychologist Counseling (Licence: OR 3394) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2023-04-03 |