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General NPI Number Information
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NPI Number | 1457948861
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Entity Type | Individual
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Provider Name | CHARISSA HOSSEINI PHD
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Gender | Female
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 150 MUIR RD
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City | MARTINEZ
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State | CA
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Zip | 94553-4668
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Country | US
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Telephone | 925-372-2537
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 NORTHSIDE AVE APT B
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City | BERKELEY
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State | CA
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Zip | 94702-1121
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Country | US
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Telephone | 408-898-0389
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32309
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32309
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License Number State | CA
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