MEDICARE: PSYCHOLOGICAL SERVICES CENTER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1588920441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL SERVICES CENTER

Provider Business Mailing Address
First Line	:	1440 BROADWAY
Second Line	:	SUITE 610
City	:	OAKLAND
State	:	CA
Zip	:	94612-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 BROADWAY
Second Line	:	SUITE 610
City	:	OAKLAND
State	:	CA
Zip	:	94612-2041
Country	:	US
Telephone Number	:	510-628-9065
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH MILNES
Credential	:	PSYD
Telephone Number	:	510-628-9065

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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Directions to “PSYCHOLOGICAL SERVICES CENTER ” Practice Location

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