1063473619 NPI number — DR. BENITA HELMLINGER PHD PSYCHOLOGY

Table of content: DR. BENITA HELMLINGER PHD PSYCHOLOGY (NPI 1063473619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063473619 NPI number — DR. BENITA HELMLINGER PHD PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HELMLINGER
Provider First Name:
BENITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELMLINGER
Provider Other First Name:
TRUDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063473619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2740 FULTON AVE
Provider Second Line Business Mailing Address:
#113
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-485-4119
Provider Business Mailing Address Fax Number:
916-944-7312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 FULTON AVE
Provider Second Line Business Practice Location Address:
#113
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-485-4119
Provider Business Practice Location Address Fax Number:
916-944-7312
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY10915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0070722 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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