NPI | 1659631935 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05118) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 1000795) |
103TC0700X Psychologist, Clinical (Licence: NY 019034) | |
Enumeration Date | 2012-05-21 |
Last Update Date | 2015-06-01 |