Provider Demographics
NPI:1710030630
Name:RAPPOPORT, ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:RAPPOPORT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DOYLE ST.
Mailing Address - Street 2:STE. #13
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4515
Mailing Address - Country:US
Mailing Address - Phone:650-323-7875
Mailing Address - Fax:650-599-9802
Practice Address - Street 1:1010 DOYLE ST.
Practice Address - Street 2:STE. #13
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4515
Practice Address - Country:US
Practice Address - Phone:650-323-7875
Practice Address - Fax:650-599-9802
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8325103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83250Medicare ID - Type Unspecified