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General NPI Number Information
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NPI Number | 1790975282
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Entity Type | Individual
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Provider Name | MAELISA M HALL PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 7600 E. GRAVES AVE
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City | ROSEMEAD
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State | CA
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Zip | 91770-3414
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Country | US
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Telephone | 626-537-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 3579 E FOOTHILL BLVD #219
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City | PASADENA
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State | CA
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Zip | 91107-3119
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Country | US
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Telephone | 818-388-7956
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 25295
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License Number State | CA
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