Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1275927394 |
---|---|
Provider Name | Sushma Taylor |
First Address | San Rafael, CA 94903-2023 |
Second Address | San Rafael, CA 94903-2023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/03/2015 |