MEDICARE: SAN FRANCISCO DBT CENTER: PSYCHOLOGICAL CORPORATION

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1912057332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN FRANCISCO DBT CENTER: PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	1735A UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4406
Country	:	US
Telephone Number	:	415-775-0475
Fax Number	:	415-345-1923

Provider Business Practice Location Address
First Line	:	1735A UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4406
Country	:	US
Telephone Number	:	415-775-0475
Fax Number	:	415-345-1923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEBORAH MITCHELL
Credential	:	PH.D.
Telephone Number	:	415-271-6524

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	01/21/2009

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