Provider Demographics
NPI:1346420320
Name:RISKIN BANKER PSYCHOTHERAPY
Entity Type:Organization
Organization Name:RISKIN BANKER PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-953-9882
Mailing Address - Street 1:1913 E 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8627
Mailing Address - Country:US
Mailing Address - Phone:714-953-9882
Mailing Address - Fax:714-953-2094
Practice Address - Street 1:1913 E 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8627
Practice Address - Country:US
Practice Address - Phone:714-953-9882
Practice Address - Fax:714-953-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty