Healthcare Provider Details

I. General information

NPI: 1093193914
Provider Name (Legal Business Name): SIMON NATHAN FERBER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY 610
OAKLAND CA
94612
US

IV. Provider business mailing address

500 12TH ST STE 101
OAKLAND CA
94607-4076
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-9065
  • Fax:
Mailing address:
  • Phone: 415-346-8640
  • Fax: 415-563-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: