| NPI | 1558694307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10167) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC 6102) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 6102) | |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2019-03-15 |