Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1003387085 |
---|---|
Provider Name | Marsha Josephine Wainwright |
First Address | Fairfield, CA 94533-7788 |
Second Address | Emeryville, CA 94608-2609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0 | 0 (01) | |
0 | UNKNOWN (01) | CA |