Healthcare Provider Details

I. General information

NPI: 1063085991
Provider Name (Legal Business Name): JOSEPH ROBERT CRIVELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WHIPPLE RD BLDG A
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

1605 DOVETAIL WAY
GILROY CA
95020-8306
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-4871
  • Fax: 510-675-4648
Mailing address:
  • Phone: 408-840-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: