Healthcare Provider Details

I. General information

NPI: 1528168366
Provider Name (Legal Business Name): GREGORY SETH ALTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date: 06/28/2022
Reactivation Date: 08/08/2022

III. Provider practice location address

5666 TELEGRAPH AVE
OAKLAND CA
94609-1708
US

IV. Provider business mailing address

3048 RICHMOND BLVD
OAKLAND CA
94611-5847
US

V. Phone/Fax

Practice location:
  • Phone: 510-545-6463
  • Fax: 510-217-3588
Mailing address:
  • Phone: 510-545-6463
  • Fax: 510-217-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY7422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY7422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY7422
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY7422
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7422
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY7422
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY7422
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY7422
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7422
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPSY7422
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPSY7422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: