NPI | 1942359963 |
---|---|
Former Name | REBECCA B CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10072) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01399) |
Enumeration Date | 2007-01-09 |
Last Update Date | 2022-10-19 |