Healthcare Provider Details

I. General information

NPI: 1699327692
Provider Name (Legal Business Name): FAMILY SPRING PSYCHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ASHBY AVE STE 1
BERKELEY CA
94705-2200
US

IV. Provider business mailing address

2615 ASHBY AVE STE 1
BERKELEY CA
94705-2200
US

V. Phone/Fax

Practice location:
  • Phone: 510-470-5777
  • Fax:
Mailing address:
  • Phone: 510-470-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL HIMELSTEIN
Title or Position: CEO
Credential: PHD
Phone: 510-470-5777