Healthcare Provider Details

I. General information

NPI: 1619155280
Provider Name (Legal Business Name): CAROLYN D. HARRIS-MUCHELL PHD, MPHCNS-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 26TH AVE
OAKLAND CA
94601-1907
US

IV. Provider business mailing address

2024 101ST AVE
OAKLAND CA
94603-3354
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-2363
  • Fax: 510-437-2366
Mailing address:
  • Phone: 510-915-8668
  • Fax: 510-562-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95001644
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number406327
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number406327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: