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General NPI Number Information
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NPI Number | 1689173759
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Entity Type | Organization
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Legal Business Name | BAY PSYCHOLOGY GROUP INC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 4900 SHATTUCK AVE UNIT 3593
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City | OAKLAND
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State | CA
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Zip | 94609-7022
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Country | US
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Telephone | 510-788-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 SHATTUCK AVE UNIT 3593
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City | OAKLAND
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State | CA
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Zip | 94609-7022
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Country | US
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Telephone | 510-788-0005
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN S SEDGELEY
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Credential | PSY.D.
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Telephone | 510-788-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY27612
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License Number State | CA
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