| NPI | 1982961868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 625) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: LA 625) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: LA 625) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: LA 625) | |
| 103TS0200X Psychologist School (Licence: LA 625) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-06-26 |