NPIMap

Organization Active NPI

Pacific Anxiety Group

  • Cognitive & Behavioral Psychologist
  • Menlo Park, CA
National Provider Identifier
1144562828
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
PSY22248 Issued in CA
Legal business name
PACIFIC ANXIETY GROUP
Practice address
845 El Camino Real
Menlo Park, CA 94025-4807
Phone
(650) 762-8352
NPI assigned
Mar 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Matthew Holaway, PH.D.NPI 1356594816
Title
Director
Phone
(650) 995-3615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TB0200X PSY22248 CA Primary

Addresses

Primary practice location

845 El Camino Real
Menlo Park, CA 94025-4807

Mailing address

845 El Camino Real
Menlo Park, CA 94025-4807
Phone (650) 762-8352

National Provider Directory

National Provider Directory

Locations

845 El Camino Real
Menlo Park, CA 94025
Phone (650) 762-8352

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1144562828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 EL CAMINO REAL",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254807",
            "telephone_number": "650-762-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 EL CAMINO REAL",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254807",
            "telephone_number": "650-762-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC ANXIETY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "HOLAWAY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-995-3615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY22248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menlo Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.