Healthcare Provider Details

I. General information

NPI: 1811487598
Provider Name (Legal Business Name): TAYLOR PSYCHOLOGICAL INNOVATORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 VISITACION AVE STE 103
BRISBANE CA
94005-1575
US

IV. Provider business mailing address

44 VISITACION AVE STE 103
BRISBANE CA
94005-1575
US

V. Phone/Fax

Practice location:
  • Phone: 415-866-8508
  • Fax:
Mailing address:
  • Phone: 415-508-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY29272
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ENNA EMPERATRIZ TAYLOR
Title or Position: CEO
Credential: PSYD
Phone: 415-866-8508