Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 32008 | CA |
NPI | 1124631312 |
---|---|
Provider Name | Kathleen Carroll-Wray |
First Address | Los Angeles, CA 90017-3476 |
Second Address | Los Angeles, CA 90017-3476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |