Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSB94020558 | CA |
Y | 103TC0700X | Clinical Psychologist | PSB94020558 | CA |
NPI | 1013147404 |
---|---|
Provider Name | Dr. Jennifer Sara Lee-Dick |
First Address | Sierra Madre, CA 91024-2364 |
Second Address | Sierra Madre, CA 91024-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 12/06/2014 |