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General NPI Number Information
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NPI Number | 1023511318
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Entity Type | Organization
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Legal Business Name | PSYNERGY PROGRAMS, INC.
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 4616 ROOSEVELT AVE
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City | SACRAMENTO
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State | CA
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Zip | 95820-4520
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Country | US
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Telephone | 916-457-3129
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Fax |
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Provider Business Mailing Address
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Address Line | 18225 HALE AVE
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City | MORGAN HILL
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State | CA
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Zip | 95037-3547
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Country | US
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Telephone | 408-465-8280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | ARTURO URIBE
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Credential | LCSW
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Telephone | 408-465-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22640
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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