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General NPI Number Information
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NPI Number | 1588702740
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Entity Type | Individual
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Provider Name | JOHN FERGUS FAHY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2001 DWIGHT WAY 5 NORTH
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-4896
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Fax | 510-204-4655
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Provider Business Mailing Address
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Address Line | 2001 DWIGHT WAY 5 NORTH
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City | BERKELEY
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State | CA
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Zip | 94704-2608
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Country | US
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Telephone | 510-204-4896
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Fax | 510-204-4655
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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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | PSY14056
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14056
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY14056
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | PSY14056
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License Number State | CA
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