Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3286 | WA |
Y | 103TC0700X | Clinical Psychologist | 3286 | WA |
NPI | 1013039551 |
---|---|
Provider Name | Dr. Elizabeth Tam Dexter-Mazza |
First Address | Seattle, WA 98117-4619 |
Second Address | Seattle, WA 98105-4121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |