Healthcare Provider Details

I. General information

NPI: 1477227437
Provider Name (Legal Business Name): GAURIE MITTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SHATTUCK AVE, SUITE 804/805
BERKELEY CA
94704-1210
US

IV. Provider business mailing address

2140 SHATTUCK AVE, SUITE 804/805
BERKELEY CA
94704-1210
US

V. Phone/Fax

Practice location:
  • Phone: 619-354-7400
  • Fax:
Mailing address:
  • Phone: 619-354-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35530
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: