Provider Demographics
NPI:1780752337
Name:COLE, JAMES RAYMOND (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYMOND
Last Name:COLE
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1728 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1205
Mailing Address - Country:US
Mailing Address - Phone:925-676-0747
Mailing Address - Fax:925-686-4035
Practice Address - Street 1:110 LA CASA VIA
Practice Address - Street 2:SUITE 130
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3088
Practice Address - Country:US
Practice Address - Phone:925-935-8839
Practice Address - Fax:925-686-4035
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY7183103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY071830Medicaid
CA68-0463475Medicare UPIN