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NPI Code Detail

MEDICARE: MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP

MEDICARE: MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist22214CA

General Provider Information

NPI Number : 1336376748
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP
Provider Business Mailing Address
First Line : 825 ZION ST
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2922
Country : US
Telephone Number : 530-265-2199
Fax Number : 530-265-2619
Provider Business Practice Location Address
First Line : 825 ZION ST
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2922
Country : US
Telephone Number : 530-265-2199
Fax Number : 530-265-2619
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARCIA J RENNIE
Credential : PHD
Telephone Number : 530-265-2199
Provider Enumeration Date : 06/12/2009
Last Update Date : 06/12/2009

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