| NPI | 1750837803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05795600) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00291400) |
| 305R00000X Preferred Provider Organization (Licence: NJ 44sl05751800) | |
| 305S00000X Point of Service (Licence: NJ 44sl05751800) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2023-08-07 |