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General NPI Number Information
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NPI Number | 1124377577
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Entity Type | Individual
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Provider Name | DR. COLLEEN MARIE BECKET-DAVENPORT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 1015 AILEEN ST D
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City | OAKLAND
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State | CA
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Zip | 94608-2710
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Country | US
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Telephone | 707-373-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 795 WILLOW RD
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City | MENLO PARK
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State | CA
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Zip | 94025-2539
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Country | US
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Telephone | 415-236-2499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY30368
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License Number State | CA
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