MEDICARE: MS. NAJJIYYA CHRISTINE ARNOLD PHD CANDIDATE

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
1	103T00000X	Psychologist	PSB94021376	CA
2	103TC0700X	Clinical Psychologist	PSB94021376	CA
3	103TP2701X	Group Psychotherapy Psychologist	PSB94021376	CA
4	106H00000X	Marriage & Family Therapist	IMF 73333	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1487636809	OTHER	CA	PSYCHOLOGICAL ASSISTANT REGISTRATION NO. PSB94021376
2	1487636809	OTHER	CA	MARRIAGE & FAMILY REGISTERED THERAPIST NO. IMF 73333

General Provider Information

NPI Number	:	1487636809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NAJJIYYA CHRISTINE ARNOLD PHD CANDIDATE

Provider Business Mailing Address
First Line	:	8365 STONYBECK CIR
Second Line	:	7902 GERBER ROAD, SUITE 232
City	:	SACRAMENTO
State	:	CA
Zip	:	95828-6649
Country	:	US
Telephone Number	:	916-705-6259
Fax Number	:	916-897-9744

Provider Business Practice Location Address
First Line	:	8365 STONYBECK CIR
Second Line	:	7902 GERBER ROAD, SUITE 232
City	:	SACRAMENTO
State	:	CA
Zip	:	95828-6649
Country	:	US
Telephone Number	:	916-705-6259
Fax Number	:	916-897-9744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	05/04/2015

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