Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY22051 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22051 | CA |
N | 103G00000X | Clinical Psychologist | PSY22051 | CA |
N | 103TC0700X | Clinical Psychologist | PSY22051 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY22051 | CA |
NPI | 1235388646 |
---|---|
Provider Name | Dr. Traci Sitzer |
First Address | Mather, CA 95655-4200 |
Second Address | Mather, CA 95655-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 10/09/2008 |