Provider Demographics
NPI:1326273335
Name:SCHULKIN, DAVID (MFT 52397)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SCHULKIN
Suffix:
Gender:M
Credentials:MFT 52397
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MISSION ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3661
Mailing Address - Country:US
Mailing Address - Phone:831-515-8489
Mailing Address - Fax:
Practice Address - Street 1:501 MISSION ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3661
Practice Address - Country:US
Practice Address - Phone:831-515-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52397OtherBOARD OF BEHAVIORAL SCIENCES