| NPI | 1821511718 |
|---|---|
| Former Name | NICOLE KALYN DE LUCA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 4597) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 4597) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2017-07-21 |