Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY 14601 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 14601 | CA |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103G00000X | Clinical Psychologist | PSY 14601 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 14601 | CA |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1053401455 |
---|---|
Provider Name | Dr. Tatjana Novakovic-Agopian |
First Address | San Francisco, CA 94122-5307 |
Second Address | San Francisco, CA 94115-3441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY 14601 | LICENSE (01) | CA |