Provider Demographics
NPI:1508997206
Name:ODERBERG, NOAH ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:ADAM
Last Name:ODERBERG
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 1:5435 COLLEGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1598
Mailing Address - Country:US
Mailing Address - Phone:510-428-0111
Mailing Address - Fax:510-450-0999
Practice Address - Street 1:5435 COLLEGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1598
Practice Address - Country:US
Practice Address - Phone:510-428-0111
Practice Address - Fax:510-450-0999
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13509103T00000X, 103TC0700X, 103TF0200X, 103TH0100X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL135090Medicare PIN