Healthcare Provider Details

I. General information

NPI: 1447283429
Provider Name (Legal Business Name): MELVIN JAY RABECK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 VALDEZ AVE
HALF MOON BAY CA
94019-1880
US

IV. Provider business mailing address

PO BOX 3718
HALF MOON BAY CA
94019-3718
US

V. Phone/Fax

Practice location:
  • Phone: 650-713-5913
  • Fax: 650-713-5915
Mailing address:
  • Phone: 650-713-5913
  • Fax: 650-713-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: