Healthcare Provider Details

I. General information

NPI: 1891152492
Provider Name (Legal Business Name): LEE SLOME PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 COLLEGE AVE SUITE A
OAKLAND CA
94618-1653
US

IV. Provider business mailing address

5835 COLLEGE AVE SUITE A
OAKLAND CA
94618-1653
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-2736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12758
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: