| NPI | 1619028776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 5028) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 5028) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-01-16 |