Healthcare Provider Details

I. General information

NPI: 1780017392
Provider Name (Legal Business Name): STANLEY G EINHORN PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 SOQUEL DR STE E
APTOS CA
95003-3184
US

IV. Provider business mailing address

231 TREVETHAN AVE
SANTA CRUZ CA
95062-1201
US

V. Phone/Fax

Practice location:
  • Phone: 831-359-5842
  • Fax: 831-359-5842
Mailing address:
  • Phone: 831-359-5842
  • Fax: 831-359-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY13906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY13906
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY13906
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13906
License Number StateCA

VIII. Authorized Official

Name: STANLEY G EINHORN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 831-359-5842