| Mt Diablo Memory Center, A Psychological Corporation | |
|
1910 Olympic Blvd Ste 220 Walnut Creek CA 94596-5071 | |
| (925) 988-0569 | |
| (925) 478-7930 |
| Full Name | Mt Diablo Memory Center, A Psychological Corporation |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1910 Olympic Blvd Ste 220, Walnut Creek, California |
| Authorized Official Name and Position | Eric Freitag (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9259880569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mt Diablo Memory Center, A Psychological Corporation 1910 Olympic Blvd Ste 220 Walnut Creek CA 94596-5071 Ph: (925) 988-0569 | Mt Diablo Memory Center, A Psychological Corporation 1910 Olympic Blvd Ste 220 Walnut Creek CA 94596-5071 Ph: (925) 988-0569 |
| NPI Number | 1851537450 |
|---|---|
| Provider Enumeration Date | 01/02/2009 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 7416004908 |
|---|---|
| Medicare Enrollment ID | O20090421000304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851537450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PSY21325 (California) | Primary |
| Provider Name | Eric J Freitag |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437291168 PECOS PAC ID: 8729178595 Enrollment ID: I20071217000451 |
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