Provider Demographics
NPI:1154729762
Name:PSYCHED IN SAN FRANCISCO
Entity type:Organization
Organization Name:PSYCHED IN SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA MFC51082
Authorized Official - Phone:415-520-5567
Mailing Address - Street 1:582 MARKET ST STE 1110
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5312
Mailing Address - Country:US
Mailing Address - Phone:415-520-5567
Mailing Address - Fax:
Practice Address - Street 1:582 MARKET ST STE 1110
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5312
Practice Address - Country:US
Practice Address - Phone:415-520-5567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty