Basic Information
Provider Information | |||||||||
NPI: | 1215144043 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANDREWS | ||||||||
FirstName: | SONIA | ||||||||
MiddleName: | T | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | THIMOTHEOSE | ||||||||
OtherFirstName: | SONIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PH.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 401 ROLAND WAY | ||||||||
Address2: | SUITE 100 | ||||||||
City: | OAKLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 946212034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5107462800 | ||||||||
FaxNumber: | 5107462810 | ||||||||
Practice Location | |||||||||
Address1: | 401 ROLAND WAY | ||||||||
Address2: | SUITE 100 | ||||||||
City: | OAKLAND | ||||||||
State: | CA | ||||||||
PostalCode: | 946212034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5107462800 | ||||||||
FaxNumber: | 5107462810 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2007 | ||||||||
LastUpdateDate: | 02/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY 20661 | CA | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | PSY 20661 | CA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.