Provider Demographics
NPI:1134799786
Name:MIND AND BODY PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:MIND AND BODY PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUBNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-710-4879
Mailing Address - Street 1:2409 19TH AVE STE B4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2495
Mailing Address - Country:US
Mailing Address - Phone:415-710-4879
Mailing Address - Fax:415-564-3167
Practice Address - Street 1:2409 19TH AVE STE B4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2495
Practice Address - Country:US
Practice Address - Phone:415-710-4879
Practice Address - Fax:415-564-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty