Healthcare Provider Details

I. General information

NPI: 1063996775
Provider Name (Legal Business Name): CHRISTOPHER GEORGE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

3940 VALE AVE
OAKLAND CA
94619-2222
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax:
Mailing address:
  • Phone: 925-294-0867
  • Fax: 510-848-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: