Healthcare Provider Details

I. General information

NPI: 1548586829
Provider Name (Legal Business Name): PHILIP TODD MACEACHRON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 COLLEGE AVE
BERKELEY CA
94705-2755
US

IV. Provider business mailing address

901 NEVIN AVE KAISER PERMANENTE DEPT. OF PSYCHIATRY
RICHMOND CA
94801-3143
US

V. Phone/Fax

Practice location:
  • Phone: 510-859-8553
  • Fax:
Mailing address:
  • Phone: 510-307-1667
  • Fax: 510-307-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: