Provider Demographics
NPI:1083802979
Name:TRADITIONS PSYCHIATRY GROUP, P.C
Entity Type:Organization
Organization Name:TRADITIONS PSYCHIATRY GROUP, P.C
Other - Org Name:TRADITIONS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-762-3679
Mailing Address - Street 1:900 LARKSPUR LANDING CIR STE 160
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1766
Mailing Address - Country:US
Mailing Address - Phone:707-258-8757
Mailing Address - Fax:707-253-0457
Practice Address - Street 1:1287 FULTON RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4923
Practice Address - Country:US
Practice Address - Phone:707-258-8757
Practice Address - Fax:707-253-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPS001190Medicaid
CACA298849OtherMEDICARE PTAN
CAW14877Medicare PIN