Provider Demographics
NPI:1205017290
Name:RICH-HOLTZBERG, ILENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:
Last Name:RICH-HOLTZBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NEW MONTGOMERY ST STE 420
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3429
Mailing Address - Country:US
Mailing Address - Phone:415-794-3907
Mailing Address - Fax:415-661-4039
Practice Address - Street 1:55 NEW MONTGOMERY ST STE 420
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3429
Practice Address - Country:US
Practice Address - Phone:415-794-3907
Practice Address - Fax:415-661-4039
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical