MEDICARE: ANDREW MICHAELS 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	103TC0700X	Clinical Psychologist	PSY 8036	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 8036	OTHER	CA	PSYCHOLOGIST LICENSE

General Provider Information

NPI Number	:	1649423195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MICHAELS PH.D.

Provider Business Mailing Address
First Line	:	57 SADDLE RD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2743
Country	:	US
Telephone Number	:	925-360-9929
Fax Number	:	925-933-8871

Provider Business Practice Location Address
First Line	:	3184 OLD TUNNEL RD STE A
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4153
Country	:	US
Telephone Number	:	925-360-9929
Fax Number	:	925-933-8871

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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