Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY11380 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY11380 | CA |
NPI | 1003974957 |
---|---|
Provider Name | Dr. Leslie Frances Chatham |
First Address | San Rafael, CA 94903-3410 |
Second Address | San Rafael, CA 94903-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |