Provider Demographics
NPI:1083810527
Name:CLEARWATER PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CLEARWATER PSYCHOLOGICAL SERVICES
Other - Org Name:CLEARWATER COUNSELING AND ASSESSMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-596-8137
Mailing Address - Street 1:345 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2703
Mailing Address - Country:US
Mailing Address - Phone:510-596-8137
Mailing Address - Fax:
Practice Address - Street 1:345 38TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2703
Practice Address - Country:US
Practice Address - Phone:510-596-8137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16276103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty