| NPI | 1558818765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: MA 11153) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TF0000X Psychologist Family | |
| 103T00000X Psychologist (Licence: RI PS01760) | |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2020-01-03 |