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General NPI Number Information
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NPI Number | 1902833353
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Entity Type | Individual
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Provider Name | KRISTIN WATTERSON ROKOP PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 132 E ST SUITE 320
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City | DAVIS
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State | CA
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Zip | 95616-4649
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Country | US
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Telephone | 530-304-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 450 SCHMEISER AVE
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City | DAVIS
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State | CA
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Zip | 95618-4429
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Country | US
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Telephone | 530-304-0273
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Fax | 916-482-0635
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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 | PSY21860
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License Number State | CA
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