MEDICARE: BGD PSYCHOLOGICAL SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	103TC1900X	Counseling Psychologist
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1427764596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BGD PSYCHOLOGICAL SERVICES INC

Provider Business Mailing Address
First Line	:	52 GOLF CLUB RD # 242
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1524
Country	:	US
Telephone Number	:	510-250-2805
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 KATYDID CT
Second Line	:
City	:	MARTINEZ
State	:	CA
Zip	:	94553-2221
Country	:	US
Telephone Number	:	510-250-2805
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. TAISHA CALDWELL-HARVEY
Credential	:	PHD
Telephone Number	:	510-250-2805

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	02/02/2023

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