Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 37492 | TX |
Y | 103T00000X | Psychologist | 37492 | TX |
NPI | 1003339409 |
---|---|
Provider Name | Dr. Carissa Cerda |
First Address | Austin, TX 78759-5659 |
Second Address | West Lake Hills, TX 78746-5249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 18/07/2017 |