Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1093467151 |
---|---|
Provider Name | Keri Crovella |
First Address | San Diego, CA 92127-3439 |
Second Address | San Diego, CA 92127-3439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |