Provider Demographics
NPI:1760601686
Name:UBOGY, SETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:UBOGY
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 1:1734 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2140
Mailing Address - Country:US
Mailing Address - Phone:510-847-8770
Mailing Address - Fax:510-295-2511
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 330A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-847-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19324103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL 193240Medicare ID - Type Unspecified
CAQ03517Medicare UPIN