Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY13509 | CA |
N | 103T00000X | Psychologist | PSY13509 | CA |
N | 103G00000X | Clinical Psychologist | PSY13509 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13509 | CA |
N | 103TF0200X | Forensic Psychologist | PSY13509 | CA |
N | 103TH0100X | Health Service | PSY13509 | CA |
NPI | 1508997206 |
---|---|
Provider Name | Dr. Noah Adam Oderberg |
First Address | Oakland, CA 94618-1598 |
Second Address | Oakland, CA 94618-1598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 09/07/2007 |