Provider Demographics
NPI:1447283429
Name:RABECK, MELVIN JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:JAY
Last Name:RABECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3718
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-3718
Mailing Address - Country:US
Mailing Address - Phone:650-713-5913
Mailing Address - Fax:650-713-5915
Practice Address - Street 1:236 VALDEZ AVE
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1880
Practice Address - Country:US
Practice Address - Phone:650-713-5913
Practice Address - Fax:650-713-5915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL150581Medicaid
CAR37351Medicare UPIN
CAOPL150580Medicare PIN