NPI | 1811185440 |
---|---|
Former Name | MICHELE ROSE KELLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 014520) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 014520-01) |
Enumeration Date | 2007-10-09 |
Last Update Date | 2022-07-21 |