Provider Demographics
NPI:1255807384
Name:DUMETZ, RENE (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:DUMETZ
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ALTA LOMA RD APT 605
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2436
Mailing Address - Country:US
Mailing Address - Phone:917-318-6736
Mailing Address - Fax:
Practice Address - Street 1:815 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5996
Practice Address - Country:US
Practice Address - Phone:323-509-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical