=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437478518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEDFORD E. F. PALMER II PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2010
-----------------------------------------------------
Last Update Date | 07/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 A 14TH STREET
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-761-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1928 ST. MARY'S RD, PMB 4350 SAINT MARY'S COLLEGE OF CALIFORNIA
-----------------------------------------------------
City | MORAGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-761-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 28058
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------