Provider Demographics
NPI:1083942700
Name:BATHORI PSYCHOLOGICAL GROUP, P.C.
Entity Type:Organization
Organization Name:BATHORI PSYCHOLOGICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHORI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:650-323-1225
Mailing Address - Street 1:467 HAMILTON AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1830
Mailing Address - Country:US
Mailing Address - Phone:650-323-1225
Mailing Address - Fax:650-323-1277
Practice Address - Street 1:467 HAMILTON AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1830
Practice Address - Country:US
Practice Address - Phone:650-323-1225
Practice Address - Fax:650-323-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22938103TC2200X, 103TM1800X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty