Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | CA |
NPI | 1033344015 |
---|---|
Provider Name | Lily M Rich |
First Address | Santa Cruz, CA 95060-3900 |
Second Address | Santa Cruz, CA 95060-3900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2009 |
Last Update Date | 20/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NO NUMBER | PRE-DOCTORAL INTERN (01) | CA |