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General NPI Number Information
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NPI Number | 1881068344
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Entity Type | Individual
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Provider Name | ELIZABETH MARINELLI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 1 COLLEGE DR
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-4500
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Country | US
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Telephone | 530-318-1510
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Fax | 530-542-7104
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Provider Business Mailing Address
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Address Line | PO BOX 13524
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96151-3524
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Country | US
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Telephone | 530-318-1510
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Fax | 530-542-7104
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 27630
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License Number State | CA
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