Healthcare Provider Details

I. General information

NPI: 1306520499
Provider Name (Legal Business Name): PACIFIC COGNITIVE BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BUSH ST STE 205
SAN FRANCISCO CA
94109-5279
US

IV. Provider business mailing address

1801 BUSH ST STE 205
SAN FRANCISCO CA
94109-5279
US

V. Phone/Fax

Practice location:
  • Phone: 415-689-4131
  • Fax:
Mailing address:
  • Phone: 415-689-4131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOHN ROBERT MONTOPOLI
Title or Position: PSYCHOTHERAPIST
Credential: LMFT, LPCC
Phone: 415-689-4131