Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY17051 | CA |
Y | 103T00000X | Psychologist | PSY17051 | CA |
NPI | 1003942343 |
---|---|
Provider Name | Barbara Sourkes |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P50383 | (02) | CA |
PSY170510 | (05) | CA |