Provider Demographics
NPI:1861510810
Name:NULMAN, AUDREY LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LYNNE
Last Name:NULMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:LYNNE
Other - Last Name:MANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6400 BENVENUE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1306
Mailing Address - Country:US
Mailing Address - Phone:510-655-4045
Mailing Address - Fax:
Practice Address - Street 1:5313 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1416
Practice Address - Country:US
Practice Address - Phone:510-594-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical