Healthcare Provider Details

I. General information

NPI: 1619435864
Provider Name (Legal Business Name): JOSEPH MAUCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MILLER AVE STE A
MILL VALLEY CA
94941-2858
US

IV. Provider business mailing address

155 ANDERSEN DRIVE APT 1315
SAN RAFAEL CA
94901
US

V. Phone/Fax

Practice location:
  • Phone: 916-715-4741
  • Fax:
Mailing address:
  • Phone: 916-715-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MAUCH
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 916-715-4741