Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 610 | WV |
Y | 103T00000X | Psychologist | 610 | WV |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 610 | WV |
N | 103TS0200X | School Psychologist | 21004 | WV |
NPI | 1174718415 |
---|---|
Provider Name | Mrs. Rosetta Underwood |
First Address | Middlebourne, WV 26149-9621 |
Second Address | Middlebourne, WV 26149-9621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 10/09/2007 |