Provider Demographics
NPI:1740510809
Name:MEDICAL PSYCHOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:MEDICAL PSYCHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GITTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DASHTBAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:831-621-1150
Mailing Address - Street 1:820 BAY AVE
Mailing Address - Street 2:SUITE 248
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2140
Mailing Address - Country:US
Mailing Address - Phone:831-621-1150
Mailing Address - Fax:831-621-1154
Practice Address - Street 1:820 BAY AVE
Practice Address - Street 2:SUITE 248
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2140
Practice Address - Country:US
Practice Address - Phone:831-621-1150
Practice Address - Fax:831-621-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22256103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty