Individual provider Active NPI

Ilene Rich-Holtzberg, PH.D.

  • Clinical Psychologist
  • San Francisco, CA
National Provider Identifier
1205017290
Registry record updated Nov 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY14676 Issued in CA
Practice address
55 New Montgomery St Ste 420
San Francisco, CA 94105-3429
Phone
(415) 794-3907
Fax
(415) 661-4039
NPI assigned
Nov 18, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY14676 CA Primary

Addresses

Primary practice location

55 New Montgomery St Ste 420
San Francisco, CA 94105-3429

Mailing address

55 New Montgomery St Ste 420
San Francisco, CA 94105-3429
Phone (415) 794-3907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY14676CAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1195344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195344000000",
    "number": "1205017290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NEW MONTGOMERY ST STE 420",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053429",
            "telephone_number": "415-794-3907",
            "fax_number": "415-661-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 NEW MONTGOMERY ST STE 420",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053429",
            "telephone_number": "415-794-3907",
            "fax_number": "415-661-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICH-HOLTZBERG",
        "first_name": "ILENE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-18",
        "last_updated": "2007-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY14676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2007; 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.