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General NPI Number Information
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NPI Number | 1669667499
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Entity Type | Individual
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Provider Name | JORGE SAAVEDRA PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 7 4TH ST
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City | PETALUMA
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State | CA
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Zip | 94952-3043
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Country | US
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Telephone | 510-684-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 837 2ND ST W
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City | SONOMA
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State | CA
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Zip | 95476-6904
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Country | US
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Telephone | 510-684-9100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23909
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License Number State | CA
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