Provider Demographics
NPI:1639548381
Name:BAY AREA OCD AND ANXIETY PSYCHOLOGY CLINIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BAY AREA OCD AND ANXIETY PSYCHOLOGY CLINIC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-992-4037
Mailing Address - Street 1:37 AVENIDA DE ORINDA
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2305
Mailing Address - Country:US
Mailing Address - Phone:510-992-4037
Mailing Address - Fax:510-992-4037
Practice Address - Street 1:37 AVENIDA DE ORINDA
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2305
Practice Address - Country:US
Practice Address - Phone:510-992-4037
Practice Address - Fax:510-992-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9431103K00000X
CAPSY24451103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty