Provider Demographics
NPI:1841408929
Name:WITKIN, SHARON JACKSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JACKSON
Last Name:WITKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2111
Mailing Address - Country:US
Mailing Address - Phone:510-547-3709
Mailing Address - Fax:
Practice Address - Street 1:345 38TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2703
Practice Address - Country:US
Practice Address - Phone:510-547-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical