MEDICARE: ALAMEDA NEUROPSYCH, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TF0000X	Family Psychologist
2	1041C0700X	Clinical Social Worker
3	103G00000X	Clinical Neuropsychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7336365	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1366725764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMEDA NEUROPSYCH, INC.

Provider Business Mailing Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-377-9452
Fax Number	:	510-377-9452

Provider Business Practice Location Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-337-9452
Fax Number	:	510-337-9452

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA THOMAS
Credential	:	PHD
Telephone Number	:	510-337-9452

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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