Provider Demographics
NPI: | 1326247891 |
---|---|
Name: | NEUOPSYCHOLOGY DEPARTMENT |
Entity Type: | Organization |
Organization Name: | NEUOPSYCHOLOGY DEPARTMENT |
Other - Org Name: | CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | DIRECTOR OF MENTAL HEALTH SERVICES |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHERISE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NORTHCUTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 510-428-3885 |
Mailing Address - Street 1: | 747 52ND ST |
Mailing Address - Street 2: | |
Mailing Address - City: | OAKLAND |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94609-1809 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-428-3571 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 770 53RD STREET |
Practice Address - Street 2: | |
Practice Address - City: | OAKLAND |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94609-1809 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-428-3571 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-16 |
Last Update Date: | 2007-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |