Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 25076 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 25076 | CA |
N | 103G00000X | Clinical Psychologist | PSY 25076 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 25076 | CA |
N | 103TF0200X | Forensic Psychologist | PSY 25076 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY 25076 | CA |
NPI | 1134487333 |
---|---|
Provider Name | Dr. Lyn J. Mangiameli |
First Address | Sunnyvale, CA 94086-5822 |
Second Address | San Jose, CA 95112-3648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 19/07/2012 |