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General NPI Number Information
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NPI Number | 1316527864
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Entity Type | Organization
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Legal Business Name | NORTHERN CALIFORNIA CENTER FOR INTEGRATIVE PSYCHOTHERAPY, PPC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1 BODEGA AVE STE 4
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City | PETALUMA
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State | CA
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Zip | 94952-2672
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Country | US
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Telephone | 707-992-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BODEGA AVE STE 4
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City | PETALUMA
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State | CA
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Zip | 94952-2672
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Country | US
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Telephone | 707-992-5015
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CARL SPITZER
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Credential | M.D.
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Telephone | 415-999-2994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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