Healthcare Provider Details

I. General information

NPI: 1023597226
Provider Name (Legal Business Name): CAROLYN T PHU PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date: 04/26/2023
Reactivation Date: 05/17/2023

III. Provider practice location address

721 MONTEREY BLVD
SAN FRANCISCO CA
94127-2221
US

IV. Provider business mailing address

721 MONTEREY BLVD
SAN FRANCISCO CA
94127-2221
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: