Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY19249 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY19249 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY19249 | CA |
Y | 103G00000X | Clinical Psychologist | PSY19249 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY19249 | CA |
N | 103TH0100X | Health Service | PSY19249 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY19249 | CA |
NPI | 1194964932 |
---|---|
Provider Name | Eileen Lussier |
First Address | Santa Maria, CA 93454-5909 |
Second Address | Santa Maria, CA 93454-5909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 06/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CE386Z | (02) | CA |