| NPI | 1730582008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 63559) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MT BBH-LCSW-LIC-81559) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2026-03-13 |