Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY13820 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13820 | CA |
N | 102L00000X | Psychologist | PSY13820 | CA |
N | 103T00000X | Psychologist | PSY13820 | CA |
Y | 103G00000X | Clinical Psychologist | PSY13820 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY13820 | CA |
N | 103TF0200X | Forensic Psychologist | PSY13820 | CA |
N | 103TP0814X | Psychoanalysis | PSY13820 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY13820 | CA |
NPI | 1114059664 |
---|---|
Provider Name | Dr. Carrie D. Thaler |
First Address | Albany, CA 94706-2108 |
Second Address | Albany, CA 94706-2108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2007 |
Last Update Date | 14/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OOPL138200 | (02) | CA |