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General NPI Number Information
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NPI Number | 1083914253
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Entity Type | Organization
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Legal Business Name | BAY AREA COLLABORATIVE PSYCHOLOGY GROUP, INC.
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 4000 BROADWAY SUITE 4
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City | OAKLAND
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State | CA
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Zip | 94611
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Country | US
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Telephone | 510-652-7011
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Fax | 510-380-5298
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Provider Business Mailing Address
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Address Line | 4000 BROADWAY SUITE 4
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City | OAKLAND
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State | CA
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Zip | 94611
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Country | US
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Telephone | 510-652-7011
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Fax | 510-380-5298
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. PATRICK DEAN CHRISMAN
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Credential | PSYD
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Telephone | 510-652-7011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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