| NPI | 1750478541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9930) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 114149) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-01-19 |