| NPI | 1891004990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 68018665) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 018665) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2016-12-07 |