Healthcare Provider Details

I. General information

NPI: 1679602403
Provider Name (Legal Business Name): LOUIS J ROUSSEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 KIRKHAM ST
SAN FRANCISCO CA
94122-3219
US

IV. Provider business mailing address

2109 KIRKHAM ST
SAN FRANCISCO CA
94122-3219
US

V. Phone/Fax

Practice location:
  • Phone: 415-265-4960
  • Fax:
Mailing address:
  • Phone: 415-265-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: