MEDICARE: MAHNAMANA PSYCHOTHERAPY AND MEDITATION

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

General Provider Information

NPI Number	:	1841951399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHNAMANA PSYCHOTHERAPY AND MEDITATION

Provider Business Mailing Address
First Line	:	2103 SAN JOSE AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4994
Country	:	US
Telephone Number	:	520-485-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2258 SANTA CLARA AVE STE 5
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4473
Country	:	US
Telephone Number	:	415-802-2860
Fax Number	:	844-227-8699

Authorized Official
Title or Position	:	CEO
Name	:	DR. TUCKER PECK
Credential	:
Telephone Number	:	520-485-9411

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	08/18/2023

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