Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY19663 | CA |
Y | 103T00000X | Psychologist | PSY19663 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY19663 | CA |
N | 103G00000X | Clinical Psychologist | PSY19663 | CA |
N | 103TC0700X | Clinical Psychologist | PSY19663 | CA |
N | 103TC1900X | Counseling Psychologist | PSY19663 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY19663 | CA |
N | 103TF0000X | Family Psychologist | PSY19663 | CA |
N | 103TP2701X | Group Psychotherapist | PSY19663 | CA |
NPI | 1134514748 |
---|---|
Provider Name | Dr. Jennifer Marlene Foote-Nalbach, Psy.d. |
First Address | Covina, CA 91723-1114 |
Second Address | Covina, CA 91723-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 31/03/2015 |