=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932263316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET M STAVOSKY PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 12/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7601 STONERIDGE DR
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-4501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-847-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4281 PIEDMONT AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94611-4713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-388-6388
-----------------------------------------------------
Fax | 510-581-2728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY14051
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------