Provider Demographics
NPI:1326101296
Name:GOULD, WARREN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:R
Last Name:GOULD
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 1:5710 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2250
Mailing Address - Country:US
Mailing Address - Phone:510-339-1319
Mailing Address - Fax:
Practice Address - Street 1:5710 CABOT DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2250
Practice Address - Country:US
Practice Address - Phone:510-339-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY042460Medicaid
CAPSY042460Medicaid
CA00PL42460Medicare ID - Type UnspecifiedMEDICARE