Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1043720998 |
---|---|
Provider Name | Kristen Portney |
First Address | Berkeley, CA 94709-1909 |
Second Address | Berkeley, CA 94709-1909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 05/10/2017 |