Provider Demographics
NPI:1013003565
Name:HALL, EDWARD E (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 ALHAMBRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3362
Mailing Address - Country:US
Mailing Address - Phone:916-441-2210
Mailing Address - Fax:916-442-7002
Practice Address - Street 1:418 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3362
Practice Address - Country:US
Practice Address - Phone:916-441-2210
Practice Address - Fax:916-442-7002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5552103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR26303Medicare UPIN
CA00PL55520Medicare ID - Type Unspecified