Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 021384-1 | NY |
N | 103T00000X | Psychologist | 021384-1 | NY |
Y | 102L00000X | Psychologist | PSY 4438 | CO |
Y | 103T00000X | Psychologist | PSY 4438 | CO |
NPI | 1003104431 |
---|---|
Provider Name | Magdalene L Lim |
First Address | Colorado Springs, CO 80918-3951 |
Second Address | Colorado Springs, CO 80918-3951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 07/10/2016 |