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1770926024
MARISSA DIANE BURGOYNE
ENCINO, CA
NPI
1770926024
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: CA PSY25601)
Enumeration Date
2013-04-16
Last Update Date
2013-04-16
Business Address
-- MARISSA DIANE BURGOYNE PsyD
17401 MARTHA ST
ENCINO, CA 91316-1324
Phone number: 310-487-5988
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Mailing Address
-- MARISSA DIANE BURGOYNE PsyD
17401 MARTHA ST
ENCINO, CA 91316-1324
Phone number: 310-487-5988
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