Healthcare Provider Details

I. General information

NPI: 1760262687
Provider Name (Legal Business Name): ELIZABETH MEYER MICHAEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NEVIN AVE
RICHMOND CA
94801-3016
US

IV. Provider business mailing address

2010 5TH ST UNIT 261
BERKELEY CA
94710-1988
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: