| NPI | 1972676054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CT 004779) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 004779) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-04-07 |