Individual
DR. JAIME NISENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
711 D ST STE 201, SAN RAFAEL, CA 94901-3704
(415) 516-0797
Mailing address
1 LONGVIEW AVE, SAN ANSELMO, CA 94960-2325
(415) 516-0797
(415) 456-2291
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 23623
CA
103TC0700X
Clinical Psychologist
PSY 23623
CA
103TC1900X
Counseling Psychologist
PSY 23623
CA
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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