Full Name | |
---|---|
Speciality | Psychologist - Group Psychotherapy |
Location | 19375 Hwy 116, Monte Rio, California |
Authorized Official Name and Position | Antonio Madrid (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7078651200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 519 Monte Rio CA 95462-0519 Ph: (707) 865-1200 | 19375 Hwy 116 Monte Rio CA 95462 Ph: (707) 865-1200 |
NPI Number | 1902243330 |
---|---|
Provider Enumeration Date | 05/24/2013 |
Last Update Date | 05/24/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902243330 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TP2701X | Psychologist - Group Psychotherapy | 110000330 (California) | Primary |