Provider Demographics
NPI:1346433091
Name:WANG, ALEX (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:WANG
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 1:405 KAINS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1259
Mailing Address - Country:US
Mailing Address - Phone:510-367-3439
Mailing Address - Fax:
Practice Address - Street 1:405 KAINS AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1259
Practice Address - Country:US
Practice Address - Phone:510-367-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical