Healthcare Provider Details

I. General information

NPI: 1861696635
Provider Name (Legal Business Name): JEREMY COLES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3873 HOWE ST
OAKLAND CA
94611-5343
US

IV. Provider business mailing address

4096 PIEDMONT AVE # 325
OAKLAND CA
94611-5221
US

V. Phone/Fax

Practice location:
  • Phone: 510-339-6733
  • Fax:
Mailing address:
  • Phone: 510-339-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPSY15992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY15992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: