| NPI | 1962563833 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 4907) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 4907) |
| 103TS0200X Psychologist School (Licence: MA 4907) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |