Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1316458151 |
---|---|
Provider Name | Erin Nicole Carder-Mccoy |
First Address | San Jose, CA 95125-3116 |
Second Address | San Jose, CA 95126-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2017 |
Last Update Date | 19/10/2017 |