Healthcare Provider Details

I. General information

NPI: 1821704487
Provider Name (Legal Business Name): ESSENSUATE PSYCHOLOGY GROUP, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 10/17/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 4TH STREET
SAN RAFAEL CA
94901
US

IV. Provider business mailing address

454 LAS GALLINAS AVE #3038
SAN RAFAEL CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-2626
  • Fax:
Mailing address:
  • Phone: 415-717-2626
  • 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 Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODIE NEWDELMAN
Title or Position: OWNER
Credential: PSYD
Phone: 415-717-2626