| NPI | 1649668377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH WARREN TIETZ Clinical Psychologist 510-912-3438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 22884) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |