Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 12985 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 12985 | CA |
NPI | 1013092964 |
---|---|
Provider Name | Eileen M. Maronde |
First Address | Canoga Park, CA 91304-4912 |
Second Address | Canoga Park, CA 91304-4912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 06/09/2012 |