Provider Demographics
NPI:1144386780
Name:DARWISH, AHMED (PSYD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:DARWISH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2830
Mailing Address - Country:US
Mailing Address - Phone:510-339-8221
Mailing Address - Fax:510-339-8223
Practice Address - Street 1:1955 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2830
Practice Address - Country:US
Practice Address - Phone:510-339-8221
Practice Address - Fax:510-339-8223
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL209650Medicare PIN