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1689173759 NPI number — BAY PSYCHOLOGY GROUP INC

NPI Number: 1689173759
Health Care Provider/Practitioner: BAY PSYCHOLOGY GROUP INC

Information about “1689173759” NPI (BAY PSYCHOLOGY GROUP INC) exists in 1689173759 in HTML format HTML  |  1689173759 in plain Text format TXT  |  1689173759 in PDF (Portable Document Format) PDF  |  1689173759 in an XML format XML  formats.

NPI Number : 1689173759 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689173759",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BAY PSYCHOLOGY GROUP INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4900 SHATTUCK AVE UNIT 3593",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKLAND",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94609-7022",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-788-0005",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4900 SHATTUCK AVE UNIT 3593",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAKLAND",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94609-7022",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-788-0005",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/05/2018",
    "LastUpdateDate": "04/12/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SEDGELEY",
    "AuthorizedOfficialFirstName": "BRIAN",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PSY.D.",
    "AuthorizedOfficialTelephoneNumber": "510-788-0005",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PSY27612",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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