Provider Demographics
NPI:1912185315
Name:OBBARD, EDWARD GARRETT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GARRETT
Last Name:OBBARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:
Other - Last Name:OBBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:5665 COLLEGE AVE
Mailing Address - Street 2:SUITE 340 D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1625
Mailing Address - Country:US
Mailing Address - Phone:510-495-5080
Mailing Address - Fax:
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 340 D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-495-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical