Individual
DR. KELLEY BRYAN GIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2711 ALCATRAZ AVE STE 2, BERKELEY, CA 94705-2726
(510) 219-7091
(510) 269-9031
Mailing address
2711 ALCATRAZ AVE STE 2, BERKELEY, CA 94705-2726
(510) 219-7091
(510) 269-9031
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20624
CA
103TC0700X
Clinical Psychologist
PSY 20624
CA
106H00000X
Marriage & Family Therapist
MFC 38529
CA
Other
Enumeration date
01/24/2007
Last updated
03/17/2018
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