Provider Demographics
NPI:1558492538
Name:TOOMEY, WANDA LEE (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:LEE
Last Name:TOOMEY
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SCENIC, BLDG 4
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-525-6146
Mailing Address - Fax:
Practice Address - Street 1:800 SCENIC BLDG 4
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-525-6146
Practice Address - Fax:209-525-5361
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-T0712190948374700000X
CAIMF62834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist