Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1003014739 |
---|---|
Provider Name | B L. Elliott |
First Address | Santa Rosa, CA 95405-1041 |
Second Address | San Francisco, CA 94111-1945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 18/03/2010 |