NPI | 1922285840 |
---|---|
Former Name | SUSAN ELIZABETH MIRCH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 1026) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: HI psy 1026) |
103TP2701X Psychologist, Group Psychotherapy (Licence: HI psy 1026) | |
Enumeration Date | 2008-01-22 |
Last Update Date | 2008-01-22 |