Provider Demographics
NPI:1487934816
Name:VAUGHAN, ALAN GREGORY (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GREGORY
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4531
Mailing Address - Country:US
Mailing Address - Phone:510-383-1120
Mailing Address - Fax:
Practice Address - Street 1:5625 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1599
Practice Address - Country:US
Practice Address - Phone:510-383-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102L00000X
CAPSY16575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst