Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY24131 | CA |
Y | 103G00000X | Clinical Psychologist | PSY24131 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY24131 | CA |
NPI | 1194986570 |
---|---|
Provider Name | Dr. William Gardner |
First Address | San Francisco, CA 94108-2315 |
Second Address | San Francisco, CA 94108-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 15/07/2011 |