Healthcare Provider Details

I. General information

NPI: 1497860068
Provider Name (Legal Business Name): INSTITUTE ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 GEARY BLVD
SAN FRANCISCO CA
94118-3347
US

IV. Provider business mailing address

3330 GEARY BLVD
SAN FRANCISCO CA
94118-3347
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-4180
  • Fax: 415-750-4108
Mailing address:
  • Phone: 415-750-4180
  • Fax: 415-750-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY15889
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20118
License Number StateCA

VIII. Authorized Official

Name: DR. THERESE ANTONIA TEN TUSSCHER
Title or Position: VICE PRESIDENT CLINICAL PROGRAMS
Credential: PHD
Phone: 415-750-4180