Basic Information
| Provider Information | |||||||||
| NPI: | 1619155280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS-MUCHELL | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD, MPHCNS-BC, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 101ST AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946033354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109158668 | ||||||||
| FaxNumber: | 5105622206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 26TH AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946011907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104372363 | ||||||||
| FaxNumber: | 5104372366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0807X | 406327 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent | 364SP0810X | 406327 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Family | 363LP0808X | 95001644 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.