=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801077102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOYCE CAROL ELMORE PSY. D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 11/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1151 HARBOR BAY PKWY SUITE 113
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94502-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-337-0400
-----------------------------------------------------
Fax | 510-337-9502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1151 HARBOR BAY PKWY SUITE 113
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94502-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-337-0400
-----------------------------------------------------
Fax | 510-337-9502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY21692
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------