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General NPI Number Information
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NPI Number | 1871657205
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Entity Type | Individual
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Provider Name | JAY J. JOSEPH PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5665 COLLEGE AVE SUITE 220C
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City | OAKLAND
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State | CA
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Zip | 94618-1625
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Country | US
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Telephone | 510-295-5490
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Fax | 510-540-6346
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Provider Business Mailing Address
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Address Line | PO BOX 5653
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City | BERKELEY
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State | CA
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Zip | 94705-0653
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Country | US
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Telephone | 510-295-5490
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Fax | 510-540-6346
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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 | PSY18905
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License Number State | CA
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