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NPI Code Detail

MEDICARE: CAROLYN BAHOH JAVETE PSY.D

MEDICARE: CAROLYN BAHOH JAVETE PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2103TC0700XClinical PsychologistPSY 24650CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19559OTHERSFGH INTERNAL USE ONLY
29559OTHERCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1265651574
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN BAHOH JAVETE PSY.D
Provider Business Mailing Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-779-2455
Fax Number :
Provider Business Practice Location Address
First Line : 1624 SANTA CLARA DR STE 145
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3500
Country : US
Telephone Number : 916-764-7022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 01/19/2022

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