Provider Demographics
NPI:1245458702
Name:WILLLIAM L SPIVEY PH.D. PSYCHOLOGICAL CORPORATION A PROFES CORP
Entity type:Organization
Organization Name:WILLLIAM L SPIVEY PH.D. PSYCHOLOGICAL CORPORATION A PROFES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE PHD
Authorized Official - Phone:510-893-2001
Mailing Address - Street 1:2940 SUMMIT ST
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-893-2001
Mailing Address - Fax:510-893-2027
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-893-2001
Practice Address - Fax:510-893-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11787104100000X
CAPSY6159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty