Organization
CALIFORNIA STATE UNIVERSITY FRESNO FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIANNE JACKSON PH.D. (CLINICAL DIRECTOR)
(559) 278-6773
Entity
Organization
Contact information
Practice address
4910 N CHESTNUT AVE, FRESNO, CA 93726-1852
(559) 278-6773
(559) 278-0015
Mailing address
4910 N CHESTNUT AVE, FRESNO, CA 93726-1852
(559) 278-6773
(559) 278-0015
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
03/02/2012
Last updated
01/30/2014
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