Healthcare Provider Details

I. General information

NPI: 1174768972
Provider Name (Legal Business Name): TIMOTHEA GREER MCGINLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRISON ROAD CSP SACRAMENTO
REPRESA CA
95671
US

IV. Provider business mailing address

CSP SACRAMENTO P.O. BOX 290002
REPRESA CA
95671-0001
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax:
Mailing address:
  • Phone: 916-985-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: