Healthcare Provider Details

I. General information

NPI: 1114283868
Provider Name (Legal Business Name): NEESHA PATEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 DWIGHT WAY SUITE 5
BERKELEY CA
94704-2365
US

IV. Provider business mailing address

2922 HILLEGASS AVE UNIT B
BERKELEY CA
94705-2225
US

V. Phone/Fax

Practice location:
  • Phone: 510-725-4145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 21861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: