Provider Demographics
NPI:1922321983
Name:FLEURY, THERESA MARIE (THERESA FLEURY, PHD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:FLEURY
Suffix:
Gender:F
Credentials:THERESA FLEURY, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 COLLEGE AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1625
Mailing Address - Country:US
Mailing Address - Phone:510-843-7055
Mailing Address - Fax:510-843-7055
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-843-7055
Practice Address - Fax:510-843-7055
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist