Provider Demographics
NPI:1629132444
Name:SOLLAZZO, JODY (PSYCHOLOGY, MA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SOLLAZZO
Suffix:
Gender:F
Credentials:PSYCHOLOGY, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 8TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1446
Mailing Address - Country:US
Mailing Address - Phone:510-684-0599
Mailing Address - Fax:
Practice Address - Street 1:3801 3RD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1409
Practice Address - Country:US
Practice Address - Phone:415-970-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist