Provider Demographics
NPI:1689726994
Name:IDELSON, JEFF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:IDELSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 TICE VALLEY BLVD
Mailing Address - Street 2:#248
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2203
Mailing Address - Country:US
Mailing Address - Phone:925-938-7057
Mailing Address - Fax:925-935-0965
Practice Address - Street 1:1809 MEADOW LANE
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2203
Practice Address - Country:US
Practice Address - Phone:925-938-7057
Practice Address - Fax:925-935-0965
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist