Individual
AMANDA JAYNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2640 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94704-3238
(510) 981-5290
(510) 981-5265
Mailing address
2640 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94704-3238
(510) 981-5290
(510) 981-5265
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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