Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY24712 | CA |
Y | 103T00000X | Psychologist | PSY24712 | CA |
NPI | 1013107135 |
---|---|
Provider Name | Dr. Michael Christopher Changaris |
First Address | Berkeley, CA 94707-2001 |
Second Address | Berkeley, CA 94707-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 15/02/2012 |