Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 14591 | CA |
NPI | 1003104001 |
---|---|
Provider Name | Marsha Leah Wylie |
First Address | Ventura, CA 93003-6726 |
Second Address | Camarillo, CA 93012-8704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |