Provider Demographics
NPI:1487798435
Name:COLLEGIUM SCIENTIFICA
Entity type:Organization
Organization Name:COLLEGIUM SCIENTIFICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-456-0345
Mailing Address - Street 1:4938 E YALE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1576
Mailing Address - Country:US
Mailing Address - Phone:559-456-0345
Mailing Address - Fax:559-456-2814
Practice Address - Street 1:4938 E YALE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1576
Practice Address - Country:US
Practice Address - Phone:559-456-0345
Practice Address - Fax:559-456-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103T00000X
CAPSY14744103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty