| NPI | 1760451207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS006246L) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS006246L) |
| 103TS0200X Psychologist School (Licence: PA PS006246L) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |