Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20717 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20717 | CA |
NPI | 1003822578 |
---|---|
Provider Name | Dr. R. Scott Mackin |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 12/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PSY207170 | (05) | CA |