MEDICARE: MINDY WERNER-CROHN, M.D., 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	103TF0000X	Family Psychologist
3	2084P0800X	Psychiatry Physician
4	2084P0804X	Child & Adolescent Psychiatry Physician
5	103T00000X	Psychologist

General Provider Information

NPI Number	:	1871844787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDY WERNER-CROHN, M.D., INC,

Provider Business Mailing Address
First Line	:	2930 DOMINGO AVE # 218
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2454
Country	:	US
Telephone Number	:	415-686-6847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2199 MANZANITA DRIVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611
Country	:	US
Telephone Number	:	415-686-6847
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOEL CROHN
Credential	:	PH.D.
Telephone Number	:	415-686-6847

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	05/14/2024

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