NPI | 1629327226 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133000950) |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MD LBA432) |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6361000361) | |
Enumeration Date | 2012-08-29 |
Last Update Date | 2022-01-20 |