Healthcare Provider Details

I. General information

NPI: 1124465398
Provider Name (Legal Business Name): BIRCH PSYCHIATRIC SERVICES A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2397 SHATTUCK AVE STE 206
BERKELEY CA
94704-1567
US

IV. Provider business mailing address

2397 SHATTUCK AVE STE 206
BERKELEY CA
94704-1567
US

V. Phone/Fax

Practice location:
  • Phone: 510-599-9421
  • Fax:
Mailing address:
  • Phone: 510-599-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18162
License Number StateCA

VIII. Authorized Official

Name: JENNIFER BIRCH
Title or Position: CEO
Credential: PMHNP
Phone: 510-599-9421