MEDICARE: DR. CLAIRE ELLEN CRAIG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	MFT23954	CA
2	106H00000X	Marriage & Family Therapist	MFT23954	CA

General Provider Information

NPI Number	:	1285813493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAIRE ELLEN CRAIG PH.D.

Provider Business Mailing Address
First Line	:	10901 MACARTHUR BLVD
Second Line	:	202
City	:	OAKLAND
State	:	CA
Zip	:	94605-5200
Country	:	US
Telephone Number	:	510-430-1115
Fax Number	:	510-430-1116

Provider Business Practice Location Address
First Line	:	10901 MACARTHUR BLVD
Second Line	:	202
City	:	OAKLAND
State	:	CA
Zip	:	94605-5200
Country	:	US
Telephone Number	:	510-430-1115
Fax Number	:	510-430-1116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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