Provider Demographics
NPI:1285064220
Name:NORRIS, VIRGINIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 CAZNEAU AVE
Mailing Address - Street 2:APT B
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1862
Mailing Address - Country:US
Mailing Address - Phone:415-328-5736
Mailing Address - Fax:
Practice Address - Street 1:242 CAZNEAU AVE
Practice Address - Street 2:APT B
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1862
Practice Address - Country:US
Practice Address - Phone:415-328-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical