Provider Demographics
NPI:1124174925
Name:TAYLOR, WARREN TRAVIS (PHD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:TRAVIS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 17TH ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1527
Mailing Address - Country:US
Mailing Address - Phone:510-835-8255
Mailing Address - Fax:510-452-4281
Practice Address - Street 1:519 17TH ST
Practice Address - Street 2:SUITE 530
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1527
Practice Address - Country:US
Practice Address - Phone:510-835-8255
Practice Address - Fax:510-452-4281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist