| NPI | 1821212515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY4781) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-00-0285) |
| 103TC0700X Psychologist Clinical (Licence: FL PY4781) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY4781) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: FL PY4781) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-01-31 |