| NPI | 1639608169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121087) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 2011) |
| 103K00000X Behavior Analyst (Licence: RI LBA00167) | |
| 1041C0700X Social Worker, Clinical (Licence: RI ISW02940) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-07-27 |