Healthcare Provider Details

I. General information

NPI: 1730100108
Provider Name (Legal Business Name): CHARLINE DE CARLI TOCCHI PSY D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/23/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 BALD MOUNTAIN RD. 445
BROWNS VALLEY CA
95918-0445
US

IV. Provider business mailing address

PO BOX 445
BROWNS VALLEY CA
95918-0445
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-2984
  • Fax:
Mailing address:
  • Phone: 530-432-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: