Healthcare Provider Details

I. General information

NPI: 1356017354
Provider Name (Legal Business Name): MICHAELA ROSE MOSS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 SUMMIT ST STE 2D
OAKLAND CA
94609-3416
US

IV. Provider business mailing address

6114 LA SALLE AVE # 190
OAKLAND CA
94611-2802
US

V. Phone/Fax

Practice location:
  • Phone: 510-220-9020
  • Fax:
Mailing address:
  • Phone: 510-220-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: