MEDICARE: DR. DEANNA REARDON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	19231	CA

General Provider Information

NPI Number	:	1225125826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANNA REARDON PSY.D.

Provider Business Mailing Address
First Line	:	3852 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5353
Country	:	US
Telephone Number	:	510-420-8092
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 NEVADA ST
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2603
Country	:	US
Telephone Number	:	510-420-8092
Fax Number	:	206-350-0343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/15/2015

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