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General NPI Number Information
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NPI Number | 1861696635
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Entity Type | Individual
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Provider Name | JEREMY COLES PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 3873 HOWE ST
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City | OAKLAND
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State | CA
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Zip | 94611-5343
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Country | US
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Telephone | 510-339-6733
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Fax |
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Provider Business Mailing Address
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Address Line | 4096 PIEDMONT AVE # 325
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City | OAKLAND
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State | CA
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Zip | 94611-5221
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Country | US
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Telephone | 510-339-6733
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PSY15992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PSY15992
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License Number State | CA
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