Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY8317 | CA |
NPI | 1043235369 |
---|---|
Provider Name | Dr. Marianne Ross |
First Address | Laguna Beach, CA 92651-2303 |
Second Address | Laguna Beach, CA 92651-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |