| NPI | 1639293681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 4208) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4208) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 4208) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 4208) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |