| NPI | 1962666891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 8122) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 014504) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-10 |