Provider Demographics
NPI:1700177615
Name:HAZEN-WYCOFF, JANET IRENE (PSYD, MED)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:IRENE
Last Name:HAZEN-WYCOFF
Suffix:
Gender:F
Credentials:PSYD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 ATWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2707
Mailing Address - Country:US
Mailing Address - Phone:510-410-5314
Mailing Address - Fax:
Practice Address - Street 1:1955 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2830
Practice Address - Country:US
Practice Address - Phone:510-531-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical