Provider Demographics
NPI:1508509829
Name:CALIFORNIA PSYCHOLOGY CENTER
Entity Type:Organization
Organization Name:CALIFORNIA PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRACALANZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-769-0589
Mailing Address - Street 1:700 EL CAMINO REAL, SUITE 120
Mailing Address - Street 2:#1033
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:408-769-0589
Mailing Address - Fax:
Practice Address - Street 1:1116 CARLOS PRIVADA
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3537
Practice Address - Country:US
Practice Address - Phone:408-769-0589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty