| NPI | 1902955537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 010225) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 648) |
| 103TC0700X Psychologist Clinical (Licence: CT 003278) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2015-06-17 |