Individual
KATHLEEN CARROLL-WRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1514 17TH ST STE 202, SANTA MONICA, CA 90404-3443
(323) 306-0736
Mailing address
1514 17TH ST STE 202, SANTA MONICA, CA 90404-3443
(323) 306-0736
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
32008
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4608414
BUSINESS ENTITY NUMBER
CA
Enumeration date
08/26/2020
Last updated
12/05/2022
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