Basic Information
| Provider Information | |||||||||
| NPI: | 1144404419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | JULIETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POWELL | ||||||||
| OtherFirstName: | DOROTHY | ||||||||
| OtherMiddleName: | JULIETTE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PSY.D | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699103 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699103 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2007 | ||||||||
| LastUpdateDate: | 12/21/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | PSB 29250 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.