Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103G00000X | Clinical Psychologist | PSY 14788 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 14788 | CA |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TF0000X | Family Psychologist |
NPI | 1033266234 |
---|---|
Provider Name | Dr. Scott Jay Madover |
First Address | Belmont, CA 94002-2944 |
Second Address | Oakland, CA 94605-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1801983960 | ICM (01) | CA |