Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 20465 | CA |
NPI | 1003983495 |
---|---|
Provider Name | Kirsten Marcel |
First Address | Gilroy, CA 95020-5204 |
Second Address | Gilroy, CA 95020-5204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3587 | UNICARE NUMBER (01) | CA |