| NPI | 1720136583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 010620) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NY 010620) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |