Basic Information
| Provider Information | |||||||||
| NPI: | 1700331626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORE INSIGHTS PSYCHOLOGICAL GROUP, INC. | ||||||||
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| OtherOrganizationName: | CORE INSIGHTS PSYCHOLOGICAL GROUP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4096 PIEDMONT AVE | ||||||||
| Address2: | # 185 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946115221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109821000 | ||||||||
| FaxNumber: | 5102109310 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 SUMMIT ST | ||||||||
| Address2: | SUITE 2C | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109821000 | ||||||||
| FaxNumber: | 5102109310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2016 | ||||||||
| LastUpdateDate: | 04/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | GAYLE | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | LH | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5109821000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D., M.ED. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 26970 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.