Healthcare Provider Details

I. General information

NPI: 1548903016
Provider Name (Legal Business Name): CROSSROADS PSYCHOLOGICAL ASSESSMENT AND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 S BASCOM AVE STE 217
SAN JOSE CA
95124-2675
US

IV. Provider business mailing address

3880 S BASCOM AVE STE 217
SAN JOSE CA
95124-2675
US

V. Phone/Fax

Practice location:
  • Phone: 408-637-7827
  • Fax:
Mailing address:
  • Phone:
  • 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY-MARIE ARCE
Title or Position: CEO/PROVIDER
Credential: PSYD
Phone: 951-764-4968