Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1124493994 |
---|---|
Provider Name | Lisa Jean Wholey |
First Address | Westerly, RI 02891-1977 |
Second Address | Westerly, RI 02891-1977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2015 |
Last Update Date | 04/12/2015 |