Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1073846226 |
---|---|
Provider Name | Lisa Maren Davidovitz |
First Address | San Francisco, CA 94123-4407 |
Second Address | San Francisco, CA 94123-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 04/09/2009 |