Healthcare Provider Details

I. General information

NPI: 1407171580
Provider Name (Legal Business Name): CHARLES MEYERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE SUITE 201
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

989 REGAL RD
BERKELEY CA
94708-1427
US

V. Phone/Fax

Practice location:
  • Phone: 510-329-1042
  • Fax: 510-527-4800
Mailing address:
  • Phone: 510-527-1922
  • Fax: 510-527-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY3506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: