Provider Demographics
NPI:1942635859
Name:EDWARD J. HYMAN, PH.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:EDWARD J. HYMAN, PH.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-388-4479
Mailing Address - Street 1:39 SEACAPE DR
Mailing Address - Street 2:
Mailing Address - City:MUIR BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94965-9760
Mailing Address - Country:US
Mailing Address - Phone:415-388-4479
Mailing Address - Fax:415-388-5009
Practice Address - Street 1:39 SEACAPE DR
Practice Address - Street 2:
Practice Address - City:MUIR BEACH
Practice Address - State:CA
Practice Address - Zip Code:94965-9760
Practice Address - Country:US
Practice Address - Phone:415-388-4479
Practice Address - Fax:415-388-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY884OtherPSYCHOLOGY LICENSE
CAPSY5684OtherPSYCHOLOGY LICENSE