Provider Demographics
NPI:1912115098
Name:CLEARWATER PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CLEARWATER PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, ASSESSMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-662-6056
Mailing Address - Street 1:1 BATES BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2800
Mailing Address - Country:US
Mailing Address - Phone:510-596-8137
Mailing Address - Fax:510-596-8955
Practice Address - Street 1:1 BATES BLVD
Practice Address - Street 2:STE 400
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2800
Practice Address - Country:US
Practice Address - Phone:510-596-8137
Practice Address - Fax:510-596-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty