Healthcare Provider Details

I. General information

NPI: 1245458702
Provider Name (Legal Business Name): WILLLIAM L SPIVEY PH.D. PSYCHOLOGICAL CORPORATION A PROFES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 SUMMIT ST SUITE 2-A
OAKLAND CA
94609
US

IV. Provider business mailing address

2940 SUMMIT ST SUITE 2-A
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-2001
  • Fax: 510-893-2027
Mailing address:
  • Phone: 510-893-2001
  • Fax: 510-893-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY6159
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW11787
License Number StateCA

VIII. Authorized Official

Name: MR. WILLIAM LANE SPIVEY
Title or Position: OWNER PSYCHOLOGIST
Credential: DOCTORATE PHD
Phone: 510-893-2001