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NPI Code Detail

MEDICARE: DR. SHARON JACKSON WITKIN PH.D.

MEDICARE: DR. SHARON JACKSON WITKIN 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
1103TC0700XClinical PsychologistPSY 16276CA

General Provider Information

NPI Number : 1841408929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHARON JACKSON WITKIN PH.D.
Provider Business Mailing Address
First Line : 5552 GOLDEN GATE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94618-2111
Country : US
Telephone Number : 510-547-3709
Fax Number :
Provider Business Practice Location Address
First Line : 345 38TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-2703
Country : US
Telephone Number : 510-547-3709
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2007
Last Update Date : 07/08/2007

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