| Green Psychotherapy, Pc | |
|
2041 Bancroft Way Ste 202 Berkeley CA 94704-1443 | |
| (510) 612-0097 | |
| Not Available |
| Full Name | Green Psychotherapy, Pc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2041 Bancroft Way Ste 202, Berkeley, California |
| Authorized Official Name and Position | Douglas Vakoch (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5106120097 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Psychotherapy, Pc 1918 Bonita Ave Berkeley CA 94704-1014 Ph: () - | Green Psychotherapy, Pc 2041 Bancroft Way Ste 202 Berkeley CA 94704-1443 Ph: (510) 612-0097 |
| NPI Number | 1366001034 |
|---|---|
| Provider Enumeration Date | 06/06/2019 |
| Last Update Date | 01/12/2020 |
| Certification Date | 01/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366001034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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