| NPI | 1720459225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PY 8439-PR) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012862) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |