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General NPI Number Information
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NPI Number | 1326266958
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Entity Type | Individual
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Provider Name | TAMAR SARA WISHNATZKY ED.D, , M.S., B.S.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 915 UNIVERSITY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-6725
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Country | US
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Telephone | 916-925-4700
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Fax | 916-451-5355
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Provider Business Mailing Address
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Address Line | 915 UNIVERSITY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-6725
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Country | US
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Telephone | 916-925-4700
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Fax | 916-451-5355
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY#13837
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License Number State | CA
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