Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY1001260 | DC |
Y | 103TC0700X | Clinical Psychologist | PSY1001260 | DC |
NPI | 1003337320 |
---|---|
Provider Name | Dana Footer |
First Address | Baltimore, MD 21297-3215 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2017 |
Last Update Date | 28/06/2017 |