Individual
DR. BONNIE LOUISE MERRITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1501 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-6200
(510) 535-4167
Mailing address
1501 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-6200
(510) 535-4167
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY21859
CA
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-1063
FQHC MEDICARE PART A
CA
01
—
5519
BEHAVIORAL HEALTH CARE SE
CA
01
—
ZZZ29799Z
FQHC MEDICARE PART B
CA
Enumeration date
02/14/2007
Last updated
08/18/2010
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