| NPI | 1861777609 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9419) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VT 048.0134932) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2023-12-01 |