Provider Demographics
NPI:1871657205
Name:JOSEPH, JAY J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:J
Last Name:JOSEPH
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:PO BOX 5653
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-0653
Mailing Address - Country:US
Mailing Address - Phone:510-295-5490
Mailing Address - Fax:510-540-6346
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 220C
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-295-5490
Practice Address - Fax:510-540-6346
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical