Provider Demographics
NPI:1659633923
Name:PETER-FRANK, DOUGLAS P (PSYD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:PETER-FRANK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:P
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 LINCOLN AVE STE 110B
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2120
Mailing Address - Country:US
Mailing Address - Phone:415-615-2040
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVE STE 110B
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-615-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20221103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist