Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY28041 | CA |
N | 103TC0700X | Clinical Psychologist | PSY28041 | CA |
Y | 103TC1900X | Counseling Psychologist | PSY28041 | CA |
NPI | 1033569173 |
---|---|
Provider Name | Lauren Tracey Seay Dashjian |
First Address | Benicia, CA 94510-2055 |
Second Address | Benicia, CA 94510-2055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 05/04/2019 |