Healthcare Provider Details

I. General information

NPI: 1447770102
Provider Name (Legal Business Name): SPECTRUM PRACTICE OF BERKELEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SHATTUCK AVENUE SUITE 511
BERKELEY CA
94704
US

IV. Provider business mailing address

2140 SHATTUCK AVENUE SUITE 511
BERKELEY CA
94704
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-1100
  • Fax: 510-841-1101
Mailing address:
  • Phone: 510-841-1100
  • Fax: 510-841-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21262
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT93739
License Number StateCA

VIII. Authorized Official

Name: MR. JEAN CHANCE FRANCO
Title or Position: DIRECTOR
Credential: PHD
Phone: 510-841-1100