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General NPI Number Information
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NPI Number | 1972838464
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Entity Type | Individual
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Provider Name | JOANNA F. SELF PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 3629 GRAND AVE SUITE 201
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City | OAKLAND
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State | CA
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Zip | 94610-2009
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Country | US
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Telephone | 510-847-8139
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Fax | 510-452-0300
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Provider Business Mailing Address
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Address Line | 3629 GRAND AVE SUITE 201
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City | OAKLAND
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State | CA
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Zip | 94610-2009
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Country | US
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Telephone | 510-847-8139
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Fax | 510-452-0300
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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 | PSY16660
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY16660
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License Number State | CA
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