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NPI Code Detail

MEDICARE: DR. DIANE J. HARRIS-WILSON PH.D.

MEDICARE: DR. DIANE J. HARRIS-WILSON PH.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
1103T00000XPsychologistPSY 9780CA
2103T00000XPsychologist2990MA

General Provider Information

NPI Number : 1619011723
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE J. HARRIS-WILSON PH.D.
Provider Business Mailing Address
First Line : 519 17TH STREET
Second Line : SUITE 530
City : OAKLAND
State : CA
Zip : 94612-1503
Country : US
Telephone Number : 510-452-4281
Fax Number : 510-452-4281
Provider Business Practice Location Address
First Line : 519 17TH ST
Second Line : SUITE 530
City : OAKLAND
State : CA
Zip : 94612-1527
Country : US
Telephone Number : 510-452-4281
Fax Number : 510-452-4281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/08/2007

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