Healthcare Provider Details

I. General information

NPI: 1760645998
Provider Name (Legal Business Name): ANKHESENAMUN BALL MARIONI PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANKHESENAMUN BALL PSYD

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRAND AVE STE 301
OAKLAND CA
94610-3548
US

IV. Provider business mailing address

1918 BONITA AVE # 200
BERKELEY CA
94704-1014
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-7607
  • Fax:
Mailing address:
  • Phone: 510-269-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: