Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0378 | OR |
Y | 103T00000X | Psychologist | 0378 | OR |
NPI | 1003866294 |
---|---|
Provider Name | Joel Garfunkel |
First Address | Corvallis, OR 97330-3745 |
Second Address | Corvallis, OR 97330-3745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 05/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043240 | (05) | OR |
R55536 | (02) |