| NPI | 1679628648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2968) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 2968) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NC 2968) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NC 2968) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 2968) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-09 |