Healthcare Provider Details

I. General information

NPI: 1427987635
Provider Name (Legal Business Name): ELIZABETH MAX PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAISER PLZ STE 550
OAKLAND CA
94612-3611
US

IV. Provider business mailing address

642 WILLOWGATE ST
MOUNTAIN VIEW CA
94043-4816
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-5477
  • Fax:
Mailing address:
  • Phone: 630-740-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220202678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: