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General NPI Number Information
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NPI Number | 1982835419
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Entity Type | Individual
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Provider Name | RENEE MARIE WILKINSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 114 BUCCANEER ST
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5116
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Country | US
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Telephone | 213-709-0999
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Fax | 213-404-7999
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Provider Business Mailing Address
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Address Line | PO BOX 5324
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City | SANTA MONICA
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State | CA
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Zip | 90409-5324
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Country | US
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Telephone | 213-709-0999
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Fax | 213-404-7999
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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 | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 20882
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License Number State | CA
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