| NPI | 1730490574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MARCELLYN KENNEDY Sole Proprietor 219-464-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042264A) |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2010-06-26 |