Provider Demographics
NPI:1528056686
Name:PEIPMAN, FRED EDGAR WINFIELD (PHD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:EDGAR WINFIELD
Last Name:PEIPMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4009
Mailing Address - Country:US
Mailing Address - Phone:970-799-1178
Mailing Address - Fax:970-799-1178
Practice Address - Street 1:560 OXFORD AVE
Practice Address - Street 2:ROOM 1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1153
Practice Address - Country:US
Practice Address - Phone:970-799-1178
Practice Address - Fax:970-799-1178
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26578103TC1900X
CO3004103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3311WMedicare PIN
FLU311ZMedicare PIN