| Bay Psychology Group Inc | |
|
4900 Shattuck Ave Unit 3593 Oakland CA 94609-7022 | |
| (510) 788-0005 | |
| Not Available |
| Full Name | Bay Psychology Group Inc |
|---|---|
| Speciality | Psychologist |
| Location | 4900 Shattuck Ave Unit 3593, Oakland, California |
| Authorized Official Name and Position | Brian S Sedgeley (PRESIDENT) |
| Authorized Official Contact | 5107880005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bay Psychology Group Inc 4900 Shattuck Ave Unit 3593 Oakland CA 94609-7022 Ph: (510) 788-0005 | Bay Psychology Group Inc 4900 Shattuck Ave Unit 3593 Oakland CA 94609-7022 Ph: (510) 788-0005 |
| NPI Number | 1689173759 |
|---|---|
| Provider Enumeration Date | 02/05/2018 |
| Last Update Date | 04/12/2021 |
| Certification Date | 03/22/2021 |
| Medicare PECOS PAC ID | 6002178233 |
|---|---|
| Medicare Enrollment ID | O20180327002684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689173759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY27612 (California) | Primary |
| Provider Name | Brian Scott Sedgeley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770725624 PECOS PAC ID: 8022327287 Enrollment ID: I20151029000608 |
| Provider Name | Kathleen Wonacott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558620419 PECOS PAC ID: 6901235100 Enrollment ID: I20200409002906 |
| Provider Name | Kristy Annmarie Shanks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801349972 PECOS PAC ID: 7618365172 Enrollment ID: I20211102002837 |
| Provider Name | Emma Rose Sofen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841860392 PECOS PAC ID: 3577902311 Enrollment ID: I20240412003161 |
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