Provider Demographics
NPI:1164137915
Name:PSYCHOLOGY WORKS OF CALIFORNIA PC
Entity Type:Organization
Organization Name:PSYCHOLOGY WORKS OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-822-8855
Mailing Address - Street 1:655 OAK GROVE AVE UNIT 846
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94026-5002
Mailing Address - Country:US
Mailing Address - Phone:650-822-8855
Mailing Address - Fax:
Practice Address - Street 1:2156 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4502
Practice Address - Country:US
Practice Address - Phone:650-822-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)