| NPI | 1952155442 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 07108) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 07108) |
| 103T00000X Psychologist (Licence: VA 0810008497) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: VA 0810008497) | |
| 103TC0700X Psychologist Clinical (Licence: VA 0810008497) | |
| 103TF0000X Psychologist Family (Licence: VA 0810008497) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810008497) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 07108) | |
| 103TF0000X Psychologist Family (Licence: MD 07108) | |
| 103TH0004X Psychologist Health (Licence: MD 07108) | |
| 103TH0004X Psychologist Health (Licence: VA 0810008497) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: VA 0810008497) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MD 07108) | |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2024-07-31 |