Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 28683 | CA |
Y | 103TC0700X | Clinical Psychologist | 28683 | CA |
NPI | 1003335936 |
---|---|
Provider Name | Yelena Blank |
First Address | Palo Alto, CA 94304-9891 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 12/09/2017 |