MEDICARE: CODEPENDENCY PSYCHOTHERAPY CLINIC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427688548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CODEPENDENCY PSYCHOTHERAPY CLINIC

Provider Business Mailing Address
First Line	:	1311 PARK ST UNIT 638
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4507
Country	:	US
Telephone Number	:	858-922-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 PARK ST STE 2
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1420
Country	:	US
Telephone Number	:	858-922-7337
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. RACHEL ROSENFELD
Credential	:	PSYD
Telephone Number	:	858-922-7337

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	11/09/2025

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