Individual
ALLISON MARIE FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGY MA
Contact information
Practice address
15305 RAYEN ST, NORTH HILLS, CA 91343-5117
(818) 892-3423
Mailing address
744 PIER AVE APT 1, SANTA MONICA, CA 90405-4548
(818) 792-2095
(310) 317-7558
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
08/27/2018
Last updated
08/27/2018
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