Healthcare Provider Details

I. General information

NPI: 1861825879
Provider Name (Legal Business Name): ALICIA DEL PRADO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 DURANT AVE
BERKELEY CA
94704-1725
US

IV. Provider business mailing address

2728 DURANT AVE
BERKELEY CA
94704-1725
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-9230
  • Fax:
Mailing address:
  • Phone: 510-841-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number24116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: