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General NPI Number Information
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NPI Number | 1134799786
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Entity Type | Organization
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Legal Business Name | MIND AND BODY PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 06/27/2021
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Provider Practice Location Address
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Address Line | 2409 19TH AVE STE B4
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2495
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Country | US
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Telephone | 415-710-4879
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Fax | 415-564-3167
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Provider Business Mailing Address
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Address Line | 2409 19TH AVE STE B4
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2495
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Country | US
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Telephone | 415-710-4879
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Fax | 415-564-3167
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | TATIANA DOUBNOVA
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Credential | PSYD
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Telephone | 415-710-4879
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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 |
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License Number State |
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