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General NPI Number Information
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NPI Number | 1962621326
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Entity Type | Individual
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Provider Name | ANNE C DE LOVINFOSSE PH.D
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 711 D ST # 12
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3707
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Country | US
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Telephone | 415-456-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 7130 C ST
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City | EL CERRITO
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State | CA
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Zip | 94530-4109
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Country | US
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Telephone | 415-456-5502
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Fax | 510-527-4806
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 16397
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License Number State | CA
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