NPI | 1952550808 |
---|---|
Former Name | KIMBERLY ANN MICHAEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 004805) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 004805) |
Enumeration Date | 2008-09-16 |
Last Update Date | 2024-08-16 |