| NPI | 1861720088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9126) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 018307) |
| Enumeration Date | 2009-11-29 |
| Last Update Date | 2009-12-04 |