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NPI 1043336746

NPI 1043336746 : ARNELL RUBY ETHERINGTON PH.D. : SAN MATEO, CA

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General NPI Number Information
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    NPI Number           |    1043336746
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    Entity Type          |    Individual 
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    Provider Name        |    ARNELL RUBY ETHERINGTON PH.D.
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    03/22/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    205 THIRD AVE. SUITE 200D
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    City                 |    SAN MATEO
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    State                |    CA
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    Zip                  |    94402
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    Country              |    US
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    Telephone            |    650-728-1526
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    Fax                  |    650-728-3527
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Provider Business Mailing Address
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    Address Line         |    PO BOX 370392 1521 MAIN ST.
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    City                 |    MONTARA
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    State                |    CA
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    Zip                  |    94037-0392
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    Country              |    US
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    Telephone            |    650-728-1526
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    Fax                  |    650-728-3527
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    103T00000X
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    Taxonomy Name        |    Psychologist
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    License Number       |    PSY14735
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    License Number State |    CA
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