Provider Demographics
NPI:1992138374
Name:HARVEY, TODD (MFT)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-0100
Mailing Address - Country:US
Mailing Address - Phone:510-686-3390
Mailing Address - Fax:
Practice Address - Street 1:3179 COLLEGE AVE # 3-C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2755
Practice Address - Country:US
Practice Address - Phone:510-686-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist