| NPI | 1649254863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY 337) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY 367) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-04-15 |