Mack, Delores Eliza
Mack, Delores Eliza is an sole proprietor health care provider with primary practice located at 414 Yale Ave Suite F, Claremont CA 91711-4357. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Mack, Delores Eliza can be contacted via phone (909) 319-9956.Contact Information
Primary practice address
414 Yale Ave Suite F
Claremont CA 91711-4357
Phone: (909) 319-9956
Fax: (909) 946-7133
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | PSY13593 | California |
Profile Details
| NPI number | 1962555995 |
|---|---|
| LBN Legal business name | Mack, Delores Eliza |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 21st, 2007 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962555995 | NPPES |
| California | MEDICAID | 4067536 |
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