Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1184216178 |
---|---|
Provider Name | Janice David |
First Address | Fairfield, CA 94533-5711 |
Second Address | Fairfield, CA 94533-5711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2021 |
Last Update Date | 10/02/2021 |