Healthcare Provider Details

I. General information

NPI: 1770303075
Provider Name (Legal Business Name): DIANA FUERY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 DANA ST
BERKELEY CA
94705-1136
US

IV. Provider business mailing address

2702 DANA ST
BERKELEY CA
94705-1136
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-1189
  • Fax:
Mailing address:
  • Phone: 510-601-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: