Provider Demographics
NPI:1962587568
Name:COGNITIVE BEHAVIOR THERAPY CENTER
Entity type:Organization
Organization Name:COGNITIVE BEHAVIOR THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROCHESTER
Authorized Official - Last Name:MUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-456-2463
Mailing Address - Street 1:990 A ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3042
Mailing Address - Country:US
Mailing Address - Phone:415-456-2463
Mailing Address - Fax:415-453-7719
Practice Address - Street 1:990 A ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3042
Practice Address - Country:US
Practice Address - Phone:415-456-2463
Practice Address - Fax:415-785-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty