Provider Demographics
NPI:1326202946
Name:JESSICA HERBOLD PHD CLINICAL PSYCHOLOGY PRACTICE, INC.
Entity Type:Organization
Organization Name:JESSICA HERBOLD PHD CLINICAL PSYCHOLOGY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-441-6810
Mailing Address - Street 1:2142 SUTTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3120
Mailing Address - Country:US
Mailing Address - Phone:415-441-6810
Mailing Address - Fax:
Practice Address - Street 1:2142 SUTTER ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3120
Practice Address - Country:US
Practice Address - Phone:415-441-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18505251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health