Healthcare Provider Details

I. General information

NPI: 1669153094
Provider Name (Legal Business Name): CHRISTOPHER SCOTT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 VIRGINIA ST
BERKELEY CA
94709-1206
US

IV. Provider business mailing address

2402 VIRGINIA ST
BERKELEY CA
94709-1206
US

V. Phone/Fax

Practice location:
  • Phone: 510-990-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRPS299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: