Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 24070 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 24070 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 24070 | CA |
NPI | 1013060631 |
---|---|
Provider Name | Dr. Jacqueline A Josephson |
First Address | Berkeley, CA 94705-0297 |
Second Address | Oakland, CA 94618-1937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 24/05/2021 |