Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 19036 | CA |
N | 103T00000X | Psychologist | 19036 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | 19036 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 19036 | CA |
N | 103G00000X | Clinical Psychologist | 19036 | CA |
N | 103TC0700X | Clinical Psychologist | 19036 | CA |
N | 103TH0100X | Health Service | 19036 | CA |
N | 103TP2701X | Group Psychotherapist | 19036 | CA |
N | 103TR0400X | Rehabilitation Psychologist | 19036 | CA |
NPI | 1417963273 |
---|---|
Provider Name | Dr. Julie L. Wetherell |
First Address | San Diego, CA 92161-0002 |
Second Address | San Diego, CA 92161-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |