| NPI | 1811486673 |
|---|---|
| Former Name | MAURA DERRIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME CC6333) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL5292) |
| 251S00000X (Licence: ME XL5292) | |
| 251S00000X | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2023-01-03 |