Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY12302 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY12302 | CA |
N | 102L00000X | Psychologist | PSY12302 | CA |
N | 103T00000X | Psychologist | PSY12302 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY12302 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY12302 | CA |
N | 103G00000X | Clinical Psychologist | PSY12302 | CA |
N | 103TC0700X | Clinical Psychologist | PSY12302 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY12302 | CA |
N | 103TF0000X | Family Psychologist | PSY12302 | CA |
N | 103TH0100X | Health Service | PSY12302 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY12302 | CA |
N | 103TP2701X | Group Psychotherapist | PSY12302 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY12302 | CA |
NPI | 1255465266 |
---|---|
Provider Name | Dr. Stephen Drew |
First Address | San Rafael, CA 94903-0121 |
Second Address | San Rafael, CA 94903-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY123020 | (05) | CA |