Provider Demographics
NPI:1831994284
Name:PEDIATRIC PSYCHOLOGY PARTNERS PC
Entity type:Organization
Organization Name:PEDIATRIC PSYCHOLOGY PARTNERS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARRY-MENKHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-887-0445
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1760 SOLANO AVE STE 302
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2218
Practice Address - Country:US
Practice Address - Phone:508-887-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health