Healthcare Provider Details

I. General information

NPI: 1306085493
Provider Name (Legal Business Name): GABRIELLE ELIZA ANDERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 COLBY ST STE 212
BERKELEY CA
94705-2059
US

IV. Provider business mailing address

3010 COLBY ST STE 212
BERKELEY CA
94705-2059
US

V. Phone/Fax

Practice location:
  • Phone: 917-239-1081
  • Fax: 510-495-1126
Mailing address:
  • Phone: 917-239-1081
  • Fax: 510-495-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25456
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017003-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017003-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY25456
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25456
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number017003-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: