Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 31008 | CA |
NPI | 1043872872 |
---|---|
Provider Name | Dr. Emily Julia Ricketts |
First Address | Los Angeles, CA 90024-5055 |
Second Address | Los Angeles, CA 90095-5055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |