Provider Demographics
NPI:1205590668
Name:GROUP PSYCHOTHERAPY SERVICES
Entity type:Organization
Organization Name:GROUP PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-300-0786
Mailing Address - Street 1:4300 BLACK AVE UNIT 5311
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5112
Mailing Address - Country:US
Mailing Address - Phone:650-300-0786
Mailing Address - Fax:
Practice Address - Street 1:979 WOODLAND PKWY STE 101-89
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2220
Practice Address - Country:US
Practice Address - Phone:760-566-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUPWELL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty