Provider Demographics
NPI:1487857348
Name:JIBRIL, AHMED KAMIL (PSYD)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:KAMIL
Last Name:JIBRIL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 PARK BLVD # 106
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1312
Mailing Address - Country:US
Mailing Address - Phone:510-269-0424
Mailing Address - Fax:
Practice Address - Street 1:1216 E 34TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2816
Practice Address - Country:US
Practice Address - Phone:510-269-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27036103TC0700X
103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical