| NPI | 1578838512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 002222) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 022773) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2021-11-09 |