Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4573 | AZ |
NPI | 1043543812 |
---|---|
Provider Name | Dr. Synthia Puffenberger |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 26/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08258 | (05) | OH |