=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912115098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEARWATER PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2007
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BATES BLVD STE 400
-----------------------------------------------------
City | ORINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94563-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-596-8137
-----------------------------------------------------
Fax | 510-596-8955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 BATES BLVD STE 400
-----------------------------------------------------
City | ORINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94563-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-596-8137
-----------------------------------------------------
Fax | 510-596-8955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER, ASSESSMENT DIRECTOR
-----------------------------------------------------
Name | JOCELIN K SAKS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 510-662-6056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY 16276
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------