Healthcare Provider Details

I. General information

NPI: 1063550424
Provider Name (Legal Business Name): JESSICA ROBYN LIPKIND PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

IV. Provider business mailing address

1301 14TH AVE APT 3
SAN FRANCISCO CA
94122-2137
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9030
  • Fax: 510-269-9031
Mailing address:
  • Phone: 415-786-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number21623
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRPS2006095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: