Healthcare Provider Details

I. General information

NPI: 1780896027
Provider Name (Legal Business Name): JEFFREY DAVID LIVINGSTON-CARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S FAIR OAKS AVE SUNNYVALE BEHAVIORAL HEALTH
SUNNYVALE CA
94086-7913
US

IV. Provider business mailing address

660 S FAIR OAKS AVE SUNNYVALE BEHAVIORAL HEALTH
SUNNYVALE CA
94086-7913
US

V. Phone/Fax

Practice location:
  • Phone: 408-992-4844
  • Fax: 408-992-4801
Mailing address:
  • Phone: 408-992-4844
  • Fax: 408-992-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number242025
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA99970
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA99970
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number242025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: