Healthcare Provider Details

I. General information

NPI: 1700142080
Provider Name (Legal Business Name): AMY L HONIGMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 COLLEGE AVE SUITE 315
OAKLAND CA
94618-1583
US

IV. Provider business mailing address

1527 TRESTLE GLEN RD
OAKLAND CA
94610-1841
US

V. Phone/Fax

Practice location:
  • Phone: 520-421-0434
  • Fax:
Mailing address:
  • Phone: 510-421-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11755
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: