Healthcare Provider Details

I. General information

NPI: 1063225548
Provider Name (Legal Business Name): COGNITIVE BEHAVIORAL COLLECTIVE, A PROFESSIONAL LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 ORCHARD CITY DR STE 310
CAMPBELL CA
95008-2948
US

IV. Provider business mailing address

307 ORCHARD CITY DR STE 310
CAMPBELL CA
95008-2948
US

V. Phone/Fax

Practice location:
  • Phone: 408-758-0347
  • Fax:
Mailing address:
  • Phone: 408-758-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY PEREZ
Title or Position: PRESIDENT
Credential: LMFT
Phone: 707-334-0477