Provider Demographics
NPI:1750524146
Name:RG BEERY, PH.D. & J W BEERY, PH.D. PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:RG BEERY, PH.D. & J W BEERY, PH.D. PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-525-4480
Mailing Address - Street 1:298 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1216
Mailing Address - Country:US
Mailing Address - Phone:510-525-4480
Mailing Address - Fax:510-527-3370
Practice Address - Street 1:921 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2311
Practice Address - Country:US
Practice Address - Phone:510-525-4480
Practice Address - Fax:510-527-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty