Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY17813 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY17813 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY17813 | CA |
N | 103TH0004X | Health Psychologist | PSY17813 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY17813 | CA |
NPI | 1629614144 |
---|---|
Provider Name | Dr. Larisa Beckwith |
First Address | San Francisco, CA 94112-1204 |
Second Address | San Francisco, CA 94112-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 26/03/2020 |