| NPI | 1720059355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS017611) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: VA 0810003505) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810003505) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS017611) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2014-07-17 |