| Gem Psychotherapy Inc | |
|
2340 Ward St Ste 201 Berkeley CA 94705-1147 | |
| (510) 457-1755 | |
| Not Available |
| Full Name | Gem Psychotherapy Inc |
|---|---|
| Speciality | Psychologist |
| Location | 2340 Ward St Ste 201, Berkeley, California |
| Authorized Official Name and Position | Willow Banks (PRESIDENT) |
| Authorized Official Contact | 5104571755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gem Psychotherapy Inc 2340 Ward St Ste 201 Berkeley CA 94705-1147 Ph: (510) 457-1755 | Gem Psychotherapy Inc 2340 Ward St Ste 201 Berkeley CA 94705-1147 Ph: (510) 457-1755 |
| NPI Number | 1902588601 |
|---|---|
| Provider Enumeration Date | 08/02/2023 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Medicare PECOS PAC ID | 6800241704 |
|---|---|
| Medicare Enrollment ID | O20231109002654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902588601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Willow Banks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043363732 PECOS PAC ID: 7618322512 Enrollment ID: I20231109002721 |
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