| NPI | 1932306966 |
|---|---|
| Former Name | PAMELA MARIE MORTELLARO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 1109) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 1109) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-08 |