MARIN NEUROPSYCHOLOGY AND PSYCHOLOGICAL CENTER, PC

2154 4TH ST, SAN RAFAEL, CA, 949012684

atlas:atm_npi_1003102393

Block 2017Block Group 2Census Tract 1090.02Marin County California United States

What is stored

phone: 415-457-3451
status: A
address: 2154 4TH ST, SAN RAFAEL, CA, 949012684
fax: 415-457-3819
npi: 1003102393
license: PSY13957
taxonomy: Clinical Neuropsychologist
other names: []
last updated: 2011-06-24
license state: CA
taxonomy code: 103G00000X
all taxonomies: ["Clinical Neuropsychologist"]
enumeration date: 2011-06-24
enumeration type: NPI-2
practice locations: 0
authorized official: EDGAR ANGELONE
organizational subpart: NO

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{
  "fax": "415-457-3819",
  "npi": "1003102393",
  "phone": "415-457-3451",
  "status": "A",
  "address": "2154 4TH ST, SAN RAFAEL, CA, 949012684",
  "license": "PSY13957",
  "taxonomy": "Clinical Neuropsychologist",
  "other_names": [],
  "last_updated": "2011-06-24",
  "license_state": "CA",
  "taxonomy_code": "103G00000X",
  "all_taxonomies": [
    "Clinical Neuropsychologist"
  ],
  "enumeration_date": "2011-06-24",
  "enumeration_type": "NPI-2",
  "practice_locations": 0,
  "authorized_official": "EDGAR ANGELONE",
  "organizational_subpart": "NO"
}