| NPI | 1730267923 |
|---|---|
| Former Name | STACIE JEAN BRENNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016440) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 3030) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-04-25 |