| NPI | 1902046907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8499) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8499) |
| 261QV0200X Clinic/Center, VA (Licence: MA 8499) | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2017-04-13 |