Provider Demographics
NPI:1396772471
Name:HUMPHREY, VIRGINIA POTTER (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:POTTER
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WELCH ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1803
Mailing Address - Country:US
Mailing Address - Phone:650-321-1700
Mailing Address - Fax:650-325-1700
Practice Address - Street 1:900 WELCH ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1803
Practice Address - Country:US
Practice Address - Phone:650-321-1700
Practice Address - Fax:650-325-1700
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL104630Medicare ID - Type UnspecifiedPSYCHOLOGY BILLING NUMBER