Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1003498593 |
---|---|
Provider Name | Shelly Baer |
First Address | Reseda, CA 91335-2813 |
Second Address | Reseda, CA 91335-2813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2021 |
Last Update Date | 10/09/2021 |