| Live Oak Psychological Services, Pc | |
|
2020 Milvia St Ste 450 Berkeley CA 94704-1297 | |
| (510) 214-2110 | |
| Not Available |
| Full Name | Live Oak Psychological Services, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 2020 Milvia St Ste 450, Berkeley, California |
| Authorized Official Name and Position | Susan Ryan (PRESIDENT) |
| Authorized Official Contact | 5102142110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Psychological Services, Pc 107 Tamalpais Rd Berkeley CA 94708-1948 Ph: (510) 872-6631 | Live Oak Psychological Services, Pc 2020 Milvia St Ste 450 Berkeley CA 94704-1297 Ph: (510) 214-2110 |
| NPI Number | 1891558433 |
|---|---|
| Provider Enumeration Date | 02/05/2024 |
| Last Update Date | 02/05/2024 |
| Certification Date | 02/05/2024 |
| Medicare PECOS PAC ID | 2769820976 |
|---|---|
| Medicare Enrollment ID | O20240408001718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891558433 | NPI | - | NPPES |
| 1326523044 | Other | CA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Susan Christine Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326523044 PECOS PAC ID: 3678911880 Enrollment ID: I20240408001748 |
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