Adisa Anderson, PH.D.
Individual provider Active NPI Counseling Psychologist · Berkeley, CA
NPI 1174938542 · NPPES record last updated Mar 12, 2025
Key facts
- NPI
- 1174938542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 28984 (CA)
- Practice address
- 2222 Bancroft Way
#4300
Berkeley, CA 94720-4300 - Phone
- (510) 934-6255
- NPI assigned
- Jun 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28984 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Counseling Psychologist | 103TC1900X | 28984 | CA | Yes |
Addresses
Primary practice location
2222 Bancroft Way
#4300
Berkeley, CA 94720-4300
Mailing address
2222 Bancroft Way SPC 4300
Berkeley, CA 94720-4300
Phone (510) 934-6255
Other providers in Berkeley, CA
- Vivek Raj Anand
- Naga Srilaxmi Anaparthi
- Jane Anastos
- Madison Andersen
- Abba Anderson
- Bridgette Anderson
- Elizabeth Jean Anderson
- Gabrielle Eliza Anderson
- Gary Anderson
- James Vernon Anderson
All providers in Berkeley, CA · Counseling Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.