Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | LEP 3707 | CA |
NPI | 1083157887 |
---|---|
Provider Name | Dr. Jeanne Anne Marie Carriere |
First Address | Santa Ana, CA 92705-5518 |
Second Address | Santa Ana, CA 92705-5518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |