Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CA |
NPI | 1598049363 |
---|---|
Provider Name | Miss Marie Elizabeth Goess-Saurau |
First Address | Antioch, CA 94509 |
Second Address | Antioch, CA 94509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 28/09/2011 |