Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY25229 | CA |
Y | 103G00000X | Clinical Psychologist | PSY25229 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY25229 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY25229 | CA |
N | 103TP2701X | Group Psychotherapist | PSY25229 | CA |
NPI | 1265749790 |
---|---|
Provider Name | Dr. Samuel Himelstein |
First Address | Oakland, CA 94605-4229 |
Second Address | Oakland, CA 94605-4229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 13/07/2019 |