Provider Demographics
NPI:1760672430
Name:PERRY, RON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:PERRY
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 1:6306 ROCKY POINT CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3132
Mailing Address - Country:US
Mailing Address - Phone:510-926-8552
Mailing Address - Fax:510-842-0034
Practice Address - Street 1:2380 ELLSWORTH ST STE A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1569
Practice Address - Country:US
Practice Address - Phone:510-926-8552
Practice Address - Fax:510-842-0034
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical