Healthcare Provider Details

I. General information

NPI: 1629126909
Provider Name (Legal Business Name): CALLUM DREW EASTWOOD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 COLLEGE AVE 320B
OAKLAND CA
94618-1625
US

IV. Provider business mailing address

1335 STANFORD AVE
EMERYVILLE CA
94608-2536
US

V. Phone/Fax

Practice location:
  • Phone: 510-459-4837
  • Fax:
Mailing address:
  • Phone: 510-459-4837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 23966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: