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General NPI Number Information
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NPI Number | 1093003139
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Entity Type | Individual
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Provider Name | KATIE LEIGH MESEROLL PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1440 BROADWAY SUITE 610
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City | OAKLAND
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State | CA
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Zip | 94612-2041
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Country | US
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Telephone | 510-628-9065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1420
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City | SAUSALITO
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State | CA
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Zip | 94966-1420
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Country | US
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Telephone | 707-484-7459
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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