Provider Demographics
NPI:1366725764
Name:ALAMEDA NEUROPSYCH, INC.
Entity type:Organization
Organization Name:ALAMEDA NEUROPSYCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-337-9452
Mailing Address - Street 1:1516 OAK ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2947
Mailing Address - Country:US
Mailing Address - Phone:510-377-9452
Mailing Address - Fax:510-377-9452
Practice Address - Street 1:1516 OAK ST
Practice Address - Street 2:SUITE 313
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2947
Practice Address - Country:US
Practice Address - Phone:510-337-9452
Practice Address - Fax:510-337-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7336365OtherAETNA