Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY19762 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY19762 | CA |
N | 102L00000X | Psychologist | PSY19762 | CA |
N | 103T00000X | Psychologist | PSY19762 | CA |
N | 103G00000X | Clinical Psychologist | PSY19762 | CA |
N | 103TC0700X | Clinical Psychologist | PSY19762 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY19762 | CA |
NPI | 1205975760 |
---|---|
Provider Name | Dr. Nancy Canning |
First Address | Berkeley, CA 94704-2608 |
Second Address | Berkeley, CA 94704-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 10/07/2007 |