Healthcare Provider Details

I. General information

NPI: 1811370653
Provider Name (Legal Business Name): JORDAN WILLIAM HAZZARD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORDAN WILLIAM HAZZARD DR. HAZZARD

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5297 COLLEGE AVE STE 107
OAKLAND CA
94618-1797
US

IV. Provider business mailing address

5297 COLLEGE AVE STE 107
OAKLAND CA
94618-1797
US

V. Phone/Fax

Practice location:
  • Phone: 415-316-3355
  • Fax: 415-390-6923
Mailing address:
  • Phone: 415-316-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35403
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number35403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: