Provider Demographics
NPI:1093014151
Name:DAVID PINGITORE, PHD, CLIN. PSYCH., INC.
Entity type:Organization
Organization Name:DAVID PINGITORE, PHD, CLIN. PSYCH., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PINGITORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-433-7132
Mailing Address - Street 1:120 GLEN EDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4319
Mailing Address - Country:US
Mailing Address - Phone:510-433-7132
Mailing Address - Fax:510-428-9042
Practice Address - Street 1:120 GLEN EDEN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4319
Practice Address - Country:US
Practice Address - Phone:510-433-7132
Practice Address - Fax:510-428-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13778261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP0L137780Medicare UPIN