Healthcare Provider Details

I. General information

NPI: 1366633406
Provider Name (Legal Business Name): WILLIAM MICHAEL PRICE PSYD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST
OAKLAND CA
94601-3424
US

IV. Provider business mailing address

1307 MILVIA ST
BERKELEY CA
94709-1934
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9091
  • Fax:
Mailing address:
  • Phone: 510-558-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 21004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: