Healthcare Provider Details

I. General information

NPI: 1780802462
Provider Name (Legal Business Name): ANDREW CONDEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 SOLANO AVE
ALBANY CA
94706-2148
US

IV. Provider business mailing address

1496 SOLANO AVE
ALBANY CA
94706-2148
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-5660
  • Fax: 510-524-3770
Mailing address:
  • Phone: 510-525-5660
  • Fax: 510-524-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: