Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY14819 | CA |
N | 103TC0700X | Clinical Psychologist | PSY14819 | CA |
N | 102L00000X | Psychologist | PSY14819 | CA |
N | 103T00000X | Psychologist | PSY14819 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY14819 | CA |
NPI | 1346377280 |
---|---|
Provider Name | Dr. Leslie Ross |
First Address | San Francisco, CA 94118-1981 |
Second Address | Berkeley, CA 94704-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P89324 | (02) | CA |