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Clinical Neuropsychologist

Copperopolis, California

Provider NPI: 1982654158

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 209-768-8689  Fax: 206-680-0252

Business Mailing Address:
Tel: 209-768-8689  Fax: 206-680-0252

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103T00000XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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