Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY24885 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY24885 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY24885 | CA |
Y | 103G00000X | Clinical Psychologist | PSY24885 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY24885 | CA |
N | 103TC1900X | Counseling Psychologist | PSY24885 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY24885 | CA |
N | 103TF0000X | Family Psychologist | PSY24885 | CA |
N | 103TP2701X | Group Psychotherapist | PSY24885 | CA |
NPI | 1063586402 |
---|---|
Provider Name | Ms. Madeleine Lorelei |
First Address | Tehachapi, CA 93561-2523 |
Second Address | Bakersfield, CA 93308-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2006 |
Last Update Date | 16/02/2021 |