Provider Demographics
NPI:1316527864
Name:NORTHERN CALIFORNIA CENTER FOR INTEGRATIVE PSYCHOTHERAPY, PPC
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA CENTER FOR INTEGRATIVE PSYCHOTHERAPY, PPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-999-2994
Mailing Address - Street 1:1 BODEGA AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2672
Mailing Address - Country:US
Mailing Address - Phone:707-992-5015
Mailing Address - Fax:
Practice Address - Street 1:1 BODEGA AVE STE 4
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2672
Practice Address - Country:US
Practice Address - Phone:707-992-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty