Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4428 | AZ |
Y | 103T00000X | Psychologist | 4428 | AZ |
NPI | 1013296045 |
---|---|
Provider Name | Dr. Patricia Groff |
First Address | Phoenix, AZ 85022-2306 |
Second Address | Phoenix, AZ 85022-6200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 18/10/2013 |