Green Psychotherapy, Pc | |
2041 Bancroft Way Ste 202 Berkeley CA 94704-1443 | |
(510) 612-0097 | |
Not Available |
Full Name | Green Psychotherapy, Pc |
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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 |
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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 |
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Provider Enumeration Date | 06/06/2019 |
Last Update Date | 01/12/2020 |
Certification Date | 01/12/2020 |
Identifier | Type | State | Issuer |
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1366001034 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Secondary |
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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