| NPI | 1609956796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 002871) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 013314) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2009-06-10 |