Healthcare Provider Details

I. General information

NPI: 1265749790
Provider Name (Legal Business Name): SAMUEL HIMELSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 KELLER AVE STE 200
OAKLAND CA
94605-4229
US

IV. Provider business mailing address

4400 KELLER AVE STE 200
OAKLAND CA
94605-4229
US

V. Phone/Fax

Practice location:
  • Phone: 510-295-8977
  • Fax:
Mailing address:
  • Phone: 510-470-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY25229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25229
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25229
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY25229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: