Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1426 | NM |
N | 103TC0700X | Clinical Psychologist | 1426 | NM |
Y | 103TR0400X | Rehabilitation Psychologist | 4618 | CO |
NPI | 1184035495 |
---|---|
Provider Name | Dr. Christine Petranovich |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 26/02/2019 |