| NPI | 1679643035 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2176) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 2176) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2176) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |