Healthcare Provider Details

I. General information

NPI: 1447380647
Provider Name (Legal Business Name): GERALD MICHAELS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 17TH ST STE 210
OAKLAND CA
94612-1527
US

IV. Provider business mailing address

5970 HARBORD DR
OAKLAND CA
94611-3125
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-9065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: