Healthcare Provider Details

I. General information

NPI: 1487810727
Provider Name (Legal Business Name): DONNA R WESTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST CHILDREN'S HOSPITAL & RESEARCH CENTER
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST CHILDREN'S HOSPITAL & RESEARCH CENTER
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-238-9764
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-238-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002941
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: