Healthcare Provider Details

I. General information

NPI: 1730417387
Provider Name (Legal Business Name): JESSICA BERNSTEIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 CANNING ST APT 2
OAKLAND CA
94609-1308
US

IV. Provider business mailing address

6280 CANNING ST APT 2
OAKLAND CA
94609-1308
US

V. Phone/Fax

Practice location:
  • Phone: 510-654-7785
  • Fax:
Mailing address:
  • Phone: 510-654-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number20969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: