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General NPI Number Information
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NPI Number | 1700177615
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Entity Type | Individual
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Provider Name | JANET IRENE HAZEN-WYCOFF PSY.D., M.ED.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 1955 MOUNTAIN BLVD SUITE 115
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City | OAKLAND
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State | CA
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Zip | 94611-2830
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Country | US
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Telephone | 510-531-8221
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 ATWELL AVE
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City | OAKLAND
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State | CA
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Zip | 94601-2707
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Country | US
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Telephone | 510-410-5314
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 23638
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License Number State | CA
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