Provider Demographics
NPI:1184823700
Name:ROBERTA SEIFERT PHD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERTA SEIFERT PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-456-1777
Mailing Address - Street 1:817 D ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2813
Mailing Address - Country:US
Mailing Address - Phone:415-456-1777
Mailing Address - Fax:415-456-0235
Practice Address - Street 1:817 D ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2813
Practice Address - Country:US
Practice Address - Phone:415-456-1777
Practice Address - Fax:415-456-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5133261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL51330Medicare UPIN