Facts
- Status
- A
- Credential
- Ph.D.
- Type
- Individual
- Enumeration date
- 2008-12-09
- Last updated
- 2008-12-09
Specialties
Licenses
- License CA
- PSY15863
Location
- Practice location
- 14295 GREEN VALLEY RD
- City
- FORESTVILLE CA
- Postal code
- 954369248
- Phone
- 707-887-1419
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.