Provider Demographics
NPI:1932785565
Name:MOVE FORWARD PSYCHOLOGY CONSULTATION PC
Entity Type:Organization
Organization Name:MOVE FORWARD PSYCHOLOGY CONSULTATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:POMFRET
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-963-3536
Mailing Address - Street 1:PO BOX 150333
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-0333
Mailing Address - Country:US
Mailing Address - Phone:415-963-3536
Mailing Address - Fax:415-963-3536
Practice Address - Street 1:870 MARKET ST STE 357
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3030
Practice Address - Country:US
Practice Address - Phone:415-963-3536
Practice Address - Fax:415-963-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty