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General NPI Number Information
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NPI Number | 1639925936
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Entity Type | Organization
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Legal Business Name | MYSAFESPACE PROFESSIONAL INC: A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1615 POLK ST STE 3
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-3698
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Country | US
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Telephone | 415-237-3598
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Fax | 628-388-3011
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Provider Business Mailing Address
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Address Line | 5432 GEARY BLVD UNIT 694
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-2307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ENOWOGHOMWENMA OSAGHAE
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Credential |
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Telephone | 415-237-3598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral 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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent 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 | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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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 #10
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #13
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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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