Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 17603 | CA |
Y | 103T00000X | Psychologist | PSY 17603 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 17603 | CA |
NPI | 1366651028 |
---|---|
Provider Name | Dr. Robin Colleen Wand |
First Address | Oakland, CA 94612-1159 |
Second Address | Oakland, CA 94612-1159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 28/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY 17603 | PSYCHOLOGY LICENSE (01) | CA |