Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 25685 | CA |
N | 103T00000X | Psychologist | 25685 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 25685 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | 25685 | CA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 25685 | CA |
N | 103G00000X | Clinical Psychologist | 25685 | CA |
N | 103TC0700X | Clinical Psychologist | 25685 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 25685 | CA |
N | 103TF0000X | Family Psychologist | 25685 | CA |
N | 103TH0004X | Health Psychologist | 25685 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 25685 | CA |
N | 103TP2701X | Group Psychotherapist | 25685 | CA |
NPI | 1235535568 |
---|---|
Provider Name | Monique Thompson |
First Address | Berkeley, CA 94708-1216 |
Second Address | Oakland, CA 94618-1462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2014 |
Last Update Date | 13/11/2014 |