Provider Demographics
NPI:1700619178
Name:RICHARDSON, AZIZI ANN (EDS)
Entity type:Individual
Prefix:
First Name:AZIZI
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:AZIZI
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDS
Mailing Address - Street 1:1011 UNION ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2236
Mailing Address - Country:US
Mailing Address - Phone:510-879-8000
Mailing Address - Fax:
Practice Address - Street 1:400 CAPISTRANO DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-3520
Practice Address - Country:US
Practice Address - Phone:510-879-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240117366103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool