| NPI | 1790011252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100452800) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 0170121) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |