Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY20986 | CA |
NPI | 1003041385 |
---|---|
Provider Name | Ethan R Schwartz |
First Address | Berkeley, CA 94705-1147 |
Second Address | Berkeley, CA 94705-1147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2009 |
Last Update Date | 30/11/2016 |