Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY21427 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY21427 | CA |
NPI | 1003033267 |
---|---|
Provider Name | Dr. Myra Gueco Bernecker |
First Address | Kentfield, CA 94904-1440 |
Second Address | Kentfield, CA 94904-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 29/07/2020 |