Provider Demographics
NPI:1417158353
Name:BANCHIK ROTHSCHILD, PATRICIA R (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:BANCHIK ROTHSCHILD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 SUMMIT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3404
Mailing Address - Country:US
Mailing Address - Phone:510-457-5105
Mailing Address - Fax:
Practice Address - Street 1:2939 SUMMIT ST STE 204
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-457-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
848030OtherBEACON HEALTH OPTIONS
CAZZZ29799ZOtherFQHC MEDICARE PART B