Individual
ALISA TITLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1426 FILLMORE ST STE 216, SAN FRANCISCO, CA 94115-4164
(415) 561-0631
Mailing address
1426 FILLMORE ST STE 216, SAN FRANCISCO, CA 94115-4164
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/01/2007
Last updated
05/07/2018
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