Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY23451 | CA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY23451 | CA |
N | 103TF0000X | Family Psychologist | PSY23451 | CA |
N | 103TP2701X | Group Psychotherapist | PSY23451 | CA |
NPI | 1144413477 |
---|---|
Provider Name | Ms. Melissa Fay Gondek |
First Address | Westlake Village, CA 91362-3600 |
Second Address | Westlake Village, CA 91362-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 24/06/2010 |