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General NPI Number Information
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NPI Number | 1326247891
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Entity Type | Organization
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Legal Business Name | NEUOPSYCHOLOGY DEPARTMENT
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 770 53RD STREET
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City | OAKLAND
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State | CA
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Zip | 94609-1809
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Country | US
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Telephone | 510-428-3571
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Fax |
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Provider Business Mailing Address
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Address Line | 747 52ND ST
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City | OAKLAND
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State | CA
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Zip | 94609-1809
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Country | US
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Telephone | 510-428-3571
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MENTAL HEALTH SERVICES
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Name | DR. CHERISE NORTHCUTT
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Credential | PH.D.
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Telephone | 510-428-3885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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