| NPI | 1912550146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ME PS2493) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 11176) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2024-02-13 |