Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 4460 | CA |
Y | 103T00000X | Psychologist | PSY 4460 | CA |
NPI | 1003934639 |
---|---|
Provider Name | Dr. Carol Lark |
First Address | Monterey, CA 93940-6113 |
Second Address | Monterey, CA 93940-6113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |