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General NPI Number Information
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NPI Number | 1356274559
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Entity Type | Organization
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Legal Business Name | PENINSULA WELLNESS PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 405 PRIMROSE RD
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City | BURLINGAME
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State | CA
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Zip | 94010-4064
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Country | US
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Telephone | 650-520-1134
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Fax | 888-557-9497
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Provider Business Mailing Address
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Address Line | 405 PRIMROSE RD STE 310
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City | BURLINGAME
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State | CA
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Zip | 94010-4092
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Country | US
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Telephone | 650-520-1134
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Fax | 888-557-9497
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | DR. DAVID LIN
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Credential | PSY.D.
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Telephone | 650-520-1134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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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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