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General NPI Number Information
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NPI Number | 1508509829
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Entity Type | Organization
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Legal Business Name | CALIFORNIA PSYCHOLOGY CENTER
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 1116 CARLOS PRIVADA
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3537
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Country | US
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Telephone | 408-769-0589
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Fax |
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Provider Business Mailing Address
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Address Line | 700 EL CAMINO REAL, SUITE 120 #1033
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City | MENLO PARK
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State | CA
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Zip | 94025
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Country | US
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Telephone | 408-769-0589
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | KATIE FRACALANZA
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Credential | PHD
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Telephone | 408-769-0589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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