| NPI | 1669769667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10136) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 003503) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2018-03-17 |