Healthcare Provider Details

I. General information

NPI: 1508628116
Provider Name (Legal Business Name): EMPOWERED PSYCHOLOGICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 4TH ST STE 401
SAN RAFAEL CA
94901-3030
US

IV. Provider business mailing address

1299 4TH ST STE 306
SAN RAFAEL CA
94901-3029
US

V. Phone/Fax

Practice location:
  • Phone: 415-505-1201
  • Fax:
Mailing address:
  • Phone: 415-505-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN CRAWFORD
Title or Position: OWNER
Credential: MA
Phone: 415-505-1201