MEDICARE: ANNICE ORMISTON PSYD

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	25092	CA

General Provider Information

NPI Number	:	1942588181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNICE ORMISTON PSYD

Provider Business Mailing Address
First Line	:	2000 HEARST AVE STE 207
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-2260
Country	:	US
Telephone Number	:	510-852-9322
Fax Number	:	888-972-2231

Provider Business Practice Location Address
First Line	:	2000 HEARST AVE STE 207
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-2260
Country	:	US
Telephone Number	:	510-852-9322
Fax Number	:	888-972-2231

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	12/11/2020

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