| NPI | 1932628963 |
|---|---|
| Former Name | CARRISSA LYNN PHILLIPPE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 3682) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022247-1) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-01-13 |