| NPI | 1679453328 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY P127887) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 118756-01) |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |