Provider Demographics
NPI:1366452161
Name:ALTMAN, MICAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 2ND ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3347
Mailing Address - Country:US
Mailing Address - Phone:707-747-9178
Mailing Address - Fax:707-747-9178
Practice Address - Street 1:801 E 2ND ST
Practice Address - Street 2:STE. 101
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3347
Practice Address - Country:US
Practice Address - Phone:707-747-9178
Practice Address - Fax:707-747-9178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10816Medicaid
CAOPL108161Medicare UPIN
CAOPL108161Medicare ID - Type Unspecified