Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY15267 | CA |
Y | 103T00000X | Psychologist | PSY15267 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY15267 | CA |
N | 103G00000X | Clinical Psychologist | PSY15267 | CA |
N | 103TC0700X | Clinical Psychologist | PSY15267 | CA |
NPI | 1366593733 |
---|---|
Provider Name | Dr. Adam L Front |
First Address | Walnut Creek, CA 94596-0730 |
Second Address | San Ramon, CA 94583-1659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2007 |
Last Update Date | 02/11/2017 |