| Lara Weyland, Ph.d., Clinical Psychology, Inc. | |
|
2220 Mountain Blvd Suite 240 Oakland CA 94611-2958 | |
| (510) 531-5354 | |
| (510) 222-3508 |
| Full Name | Lara Weyland, Ph.d., Clinical Psychology, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 2220 Mountain Blvd, Oakland, California |
| Authorized Official Name and Position | Lara Adeline Weyland (CEO/PRESIDENT) |
| Authorized Official Contact | 5105345354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lara Weyland, Ph.d., Clinical Psychology, Inc. 2220 Mountain Blvd Suite 240 Oakland CA 94611-2958 Ph: (510) 531-5354 | Lara Weyland, Ph.d., Clinical Psychology, Inc. 2220 Mountain Blvd Suite 240 Oakland CA 94611-2958 Ph: (510) 531-5354 |
| NPI Number | 1013262906 |
|---|---|
| Provider Enumeration Date | 07/17/2012 |
| Last Update Date | 07/31/2012 |
| Medicare PECOS PAC ID | 8022265859 |
|---|---|
| Medicare Enrollment ID | O20120829000434 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013262906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY14852 (California) | Primary |
| Provider Name | Lara Adeline Weyland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720187578 PECOS PAC ID: 8426234717 Enrollment ID: I20110523000266 |
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