| NPI | 1770948457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: SC 4657) | |
| 103TS0200X Psychologist, School (Licence: SC 4657) | |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2024-06-08 |