Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 96887 | CA |
NPI | 1003369141 |
---|---|
Provider Name | Laurie Kindel |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Leandro, CA 94578-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 16/09/2020 |