Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | MFC33849 | CA |
N | 103T00000X | Psychologist | MFC33849 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | MFC33849 | CA |
NPI | 1649322298 |
---|---|
Provider Name | Renee Bollo Maroon |
First Address | Napa, CA 94558-3849 |
Second Address | Napa, CA 94558-3849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 25/11/2014 |