Provider Demographics
NPI:1427225747
Name:GOETTSCHE, REBECCA SHEPARD (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHEPARD
Last Name:GOETTSCHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 SHATTUCK AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1872
Mailing Address - Country:US
Mailing Address - Phone:510-422-5220
Mailing Address - Fax:
Practice Address - Street 1:2991 SHATTUCK AVE STE 302
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1872
Practice Address - Country:US
Practice Address - Phone:510-422-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28557103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling