Provider Demographics
NPI:1700331626
Name:CORE INSIGHTS PSYCHOLOGICAL GROUP, INC.
Entity Type:Organization
Organization Name:CORE INSIGHTS PSYCHOLOGICAL GROUP, INC.
Other - Org Name:CORE INSIGHTS PSYCHOLOGICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LH
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MED
Authorized Official - Phone:510-982-1000
Mailing Address - Street 1:2940 SUMMIT ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3416
Mailing Address - Country:US
Mailing Address - Phone:510-982-1000
Mailing Address - Fax:510-210-9310
Practice Address - Street 1:2940 SUMMIT ST STE 2D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:510-982-1000
Practice Address - Fax:510-210-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA172771OtherMEDICARE PTAN