Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY24296 | CA |
NPI | 1265512115 |
---|---|
Provider Name | June Dziedzic |
First Address | San Francisco, CA 94103-2705 |
Second Address | San Francisco, CA 94103-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 25/02/2014 |