Healthcare Provider Details

I. General information

NPI: 1083942700
Provider Name (Legal Business Name): BATHORI PSYCHOLOGICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 HAMILTON AVE SUITE 22
PALO ALTO CA
94301-1830
US

IV. Provider business mailing address

467 HAMILTON AVE SUITE 22
PALO ALTO CA
94301-1830
US

V. Phone/Fax

Practice location:
  • Phone: 650-323-1225
  • Fax: 650-323-1277
Mailing address:
  • Phone: 650-323-1225
  • Fax: 650-323-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY22938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY22938
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY22938
License Number StateCA

VIII. Authorized Official

Name: DR. JON BATHORI
Title or Position: DIRECTOR
Credential: PSY.D.
Phone: 650-323-1225