| NPI | 1619968682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS1262) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012518-1) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 012518-1) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2021-08-19 |