1235741786 NPI number — SHARON J. TYSON, PH.D. AND DAVID J. FRANKEL, PH.D. A PSYCHOLOGY CORPOR

Table of content: (NPI 1235741786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235741786 NPI number — SHARON J. TYSON, PH.D. AND DAVID J. FRANKEL, PH.D. A PSYCHOLOGY CORPOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON J. TYSON, PH.D. AND DAVID J. FRANKEL, PH.D. A PSYCHOLOGY CORPOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235741786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 HEARST AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94709-2260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-525-8420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 SOLANO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94707-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-525-8420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
TYSON
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
JOAN
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
510-525-8420

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1639383656 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1104251719 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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