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General NPI Number Information
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NPI Number | 1114142361
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Entity Type | Individual
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Provider Name | BETH COOPER TABAKIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 412 RED HILL AVE SUITE #6
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2450
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Country | US
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Telephone | 415-459-7707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 823
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City | FOREST KNOLLS
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State | CA
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Zip | 94933-0823
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Country | US
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Telephone | 415-488-9108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY13580
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License Number State | CA
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