Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY2694 | CA |
N | 103T00000X | Psychologist | PSY2694 | CA |
N | 103G00000X | Clinical Psychologist | PSY2694 | CA |
N | 103TC0700X | Clinical Psychologist | PSY2694 | CA |
N | 103TC1900X | Counseling Psychologist | PSY2694 | CA |
N | 103TH0100X | Health Service | PSY2694 | CA |
N | 103TP2701X | Group Psychotherapist | PSY2694 | CA |
NPI | 1295746279 |
---|---|
Provider Name | Myrna E Blaufarb |
First Address | Los Angeles, CA 90010-3101 |
Second Address | Los Angeles, CA 90010-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |