Healthcare Provider Details

I. General information

NPI: 1174661276
Provider Name (Legal Business Name): SHIVIKA DHARAMRUP MA, PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE CRISIS & STABALIZATION UNIT/PES
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

250 BON AIR RD CRISIS & STABALIZATION UNIT/PES
GREENBRAE CA
94904
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-4140
  • Fax:
Mailing address:
  • Phone: 415-499-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number26587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: