Provider Demographics
NPI:1427127869
Name:SPIVEY, WILLIAM LANE (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LANE
Last Name:SPIVEY
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 1:2940 SUMMIT ST
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3405
Mailing Address - Country:US
Mailing Address - Phone:510-893-2001
Mailing Address - Fax:510-893-2027
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3405
Practice Address - Country:US
Practice Address - Phone:510-893-2001
Practice Address - Fax:510-893-2027
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942774250Medicare UPIN
CA00PL61590Medicare ID - Type UnspecifiedPROVIDER NUMBER