Healthcare Provider Details
I. General information
NPI: 1316484926
Provider Name (Legal Business Name): OASIS PSYCHOLOGICAL THERAPY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/21/2017
Last Update Date: 01/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5327 COLLEGE AVE
OAKLAND CA
94618-1416
US
IV. Provider business mailing address
5327 COLLEGE AVE
OAKLAND CA
94618-1416
US
V. Phone/Fax
- Phone: 510-900-9746
- Fax:
- Phone: 510-900-9746
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | PSY 28219 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LCSW 29475 |
| License Number State | CA |
VIII. Authorized Official
Name: DR.
ALLISON
AYELET
KRIEGER
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 510-900-9746