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General NPI Number Information
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NPI Number | 1518146695
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Entity Type | Organization
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Legal Business Name | PACIFIC FORENSIC PSYCHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 870 MARKET ST SUITE 1277
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-3002
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Country | US
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Telephone | 415-397-6622
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Fax | 415-397-6666
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Provider Business Mailing Address
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Address Line | 19230 SONOMA HWY SUITE 200
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City | SONOMA
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State | CA
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Zip | 95476-5474
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Country | US
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Telephone | 707-996-9398
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Fax | 707-938-8608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY-PERRY MILLER
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Credential | PHD
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Telephone | 707-996-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY16095
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License Number State | CA
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