Doctor Name: | MARISA MARES |
NPI Number: | 1033203054 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY 19781 |
Business Practice Address: | 461 W 6th St Suite 204 San Pedro, CA - 907312694 |
Business Phone Number: | 3105470084 |
Business Fax Number: | 3108335672 |
Mailing Address: | 461 W 6th St, Suite 204 SAN PEDRO |
State: | CA |
Postal Code: | 907312694 |
Phone Number: | 3105470084 |
Fax Number: | 3108335672 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 08/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PSY 19781 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |