Provider Demographics
NPI:1841591914
Name:CARR, DANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1078 SHATTUCK AVENUE #6
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709
Mailing Address - Country:US
Mailing Address - Phone:510-224-5514
Mailing Address - Fax:
Practice Address - Street 1:1078 SHATTUCK AVENUE
Practice Address - Street 2:#6
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709
Practice Address - Country:US
Practice Address - Phone:510-224-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21607103TH0100X, 103TP2701X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral