Individual
B SIMONE CARUTHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY.0002149
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11581204
CAQH
CO
01
—
C472348
MEDICARE GRP PTAN
CO
01
—
PSY.0002149
PROFESSIONAL LICENSE
CO
Enumeration date
08/12/2014
Last updated
08/12/2014
Update your record
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