Provider Demographics
NPI:1881182905
Name:PETER OPPERMANN PHD PSYCHOLOGY PROF. CORP.
Entity Type:Organization
Organization Name:PETER OPPERMANN PHD PSYCHOLOGY PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:925-878-5288
Mailing Address - Street 1:1910 OLYMPIC BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5005
Mailing Address - Country:US
Mailing Address - Phone:925-878-5288
Mailing Address - Fax:949-757-2546
Practice Address - Street 1:1910 OLYMPIC BLVD STE 330
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5005
Practice Address - Country:US
Practice Address - Phone:925-878-5288
Practice Address - Fax:949-757-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty