Healthcare Provider Details

I. General information

NPI: 1366651028
Provider Name (Legal Business Name): ROBIN COLLEEN WAND PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 SAN PABLO AVE
OAKLAND CA
94612-1159
US

IV. Provider business mailing address

2579 SAN PABLO AVE
OAKLAND CA
94612-1159
US

V. Phone/Fax

Practice location:
  • Phone: 510-446-7103
  • Fax: 510-832-0609
Mailing address:
  • Phone: 510-292-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 17603
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY 17603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: