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General NPI Number Information
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NPI Number | 1124465398
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Entity Type | Organization
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Legal Business Name | BIRCH PSYCHIATRIC SERVICES A NURSING CORPORATION
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 2397 SHATTUCK AVE STE 206
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City | BERKELEY
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State | CA
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Zip | 94704-1567
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Country | US
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Telephone | 510-599-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 2397 SHATTUCK AVE STE 206
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City | BERKELEY
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State | CA
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Zip | 94704-1567
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Country | US
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Telephone | 510-599-9421
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER BIRCH
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Credential | PMHNP
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Telephone | 510-599-9421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 18162
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License Number State | CA
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