Healthcare Provider Details

I. General information

NPI: 1033266234
Provider Name (Legal Business Name): SCOTT JAY MADOVER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE EASTMONT TOWN CENTER BLDG. B SUITE 133
OAKLAND CA
94605-2403
US

IV. Provider business mailing address

37 HERITAGE CT
BELMONT CA
94002-2944
US

V. Phone/Fax

Practice location:
  • Phone: 510-553-8500
  • Fax: 510-553-8550
Mailing address:
  • Phone: 510-553-8500
  • Fax: 510-553-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 14788
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: