Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TS0200X | School Psychologist |
NPI | 1124673173 |
---|---|
Provider Name | Mr. Shareef Nashid Salaam |
First Address | Oakland, CA 94611-5071 |
Second Address | Oakland, CA 94609-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2019 |
Last Update Date | 06/08/2019 |