Healthcare Provider Details

I. General information

NPI: 1760601686
Provider Name (Legal Business Name): SETH UBOGY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 COLLEGE AVE SUITE 330A
OAKLAND CA
94618-1625
US

IV. Provider business mailing address

1734 MARTIN LUTHER KING JR WAY
BERKELEY CA
94709-2140
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-8770
  • Fax:
Mailing address:
  • Phone: 510-847-8770
  • Fax: 510-295-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 19324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: