Individual
CARISSA DWIWARDANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3626 BALBOA ST, SAN FRANCISCO, CA 94121-2604
(415) 668-5955
Mailing address
3626 BALBOA ST, SAN FRANCISCO, CA 94121-2604
(415) 668-5955
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/02/2009
Last updated
08/31/2010
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