Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 3883 | CA |
NPI | 1053956938 |
---|---|
Provider Name | Supieri Molly Coppel |
First Address | Cupertino, CA 95014-3557 |
Second Address | Los Gatos, CA 95032-3428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |