1700177615 NPI number — DR. JANET IRENE HAZEN-WYCOFF PSY.D., M.ED.

Table of content: DR. JANET IRENE HAZEN-WYCOFF PSY.D., M.ED. (NPI 1700177615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700177615 NPI number — DR. JANET IRENE HAZEN-WYCOFF PSY.D., M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZEN-WYCOFF
Provider First Name:
JANET
Provider Middle Name:
IRENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., M.ED.
Provider Gender Code:
F

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:
1700177615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2811 ATWELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-410-5314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94611-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-531-8221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 23638 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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