Provider Demographics
NPI:1407934805
Name:PURVES, CAROLINE ANN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:PURVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 ALCATRAZ AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2726
Mailing Address - Country:US
Mailing Address - Phone:510-601-1027
Mailing Address - Fax:
Practice Address - Street 1:2711 ALCATRAZ AVE STE 4
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2726
Practice Address - Country:US
Practice Address - Phone:510-601-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL62930Medicare ID - Type Unspecified