Provider Demographics
NPI:1447770102
Name:SPECTRUM PRACTICE OF BERKELEY, INC.
Entity Type:Organization
Organization Name:SPECTRUM PRACTICE OF BERKELEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:CHANCE
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-841-1100
Mailing Address - Street 1:2140 SHATTUCK AVENUE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-841-1100
Mailing Address - Fax:510-841-1101
Practice Address - Street 1:2140 SHATTUCK AVENUE
Practice Address - Street 2:SUITE 511
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-841-1100
Practice Address - Fax:510-841-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21262103TC0700X
CALMFT93739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty