MEDICARE: DR. ROBIN COLLEEN WAND PSYD

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	103T00000X	Psychologist	PSY 17603	CA
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY 17603	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 17603	OTHER	CA	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1366651028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN COLLEEN WAND PSYD

Provider Business Mailing Address
First Line	:	2579 SAN PABLO AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1159
Country	:	US
Telephone Number	:	510-292-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2579 SAN PABLO AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1159
Country	:	US
Telephone Number	:	510-446-7103
Fax Number	:	510-832-0609

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/28/2015

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