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Organization
CALIFORNIA STATE UNIVERSITY FRESNO FOUNDATION
Active
Organization
CALIFORNIA STATE UNIVERSITY FRESNO FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIANNE JACKSON PH.D. (CLINICAL DIRECTOR)
(559) 278-6773
Entity
Organization
Contact information
Practice address
4910 N CHESTNUT AVE, FRESNO, CA 93726-1852
(559) 278-6773
(559) 278-0015
Mailing address
4910 N CHESTNUT AVE, FRESNO, CA 93726-1852
(559) 278-6773
(559) 278-0015
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
03/02/2012
Last updated
01/30/2014
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