Healthcare Provider Details

I. General information

NPI: 1871844787
Provider Name (Legal Business Name): MINDY WERNER-CROHN, M.D., INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 05/14/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 MANZANITA DRIVE
OAKLAND CA
94611
US

IV. Provider business mailing address

2930 DOMINGO AVE # 218
BERKELEY CA
94705-2454
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-6847
  • Fax:
Mailing address:
  • Phone: 415-686-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL CROHN
Title or Position: CEO
Credential: PH.D.
Phone: 415-686-6847