Healthcare Provider Details

I. General information

NPI: 1952743387
Provider Name (Legal Business Name): NAMADHJLAH RENAH MCINTOSH PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 J ST STE 315
SACRAMENTO CA
95814-2325
US

IV. Provider business mailing address

6747 FRIARS RD UNIT 121
SAN DIEGO CA
92108-5101
US

V. Phone/Fax

Practice location:
  • Phone: 951-326-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB36802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSB36802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: