Eric K Serdahl IX, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY17991 Issued in CA

Practice address

1797 Fourth St
Livermore, CA 94550-4347

Phone

(925) 443-2500

Fax

(925) 443-0771

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Del Valle Clinic, Inc

  • Clinical Psychologist
  • Livermore, CA
  • NPI 1023028248
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265469217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1797 FOURTH ST",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504347",
            "telephone_number": "925-443-2500",
            "fax_number": "925-443-0771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1797 FOURTH ST",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504347",
            "telephone_number": "925-443-2500",
            "fax_number": "925-443-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERDAHL",
        "first_name": "ERIC",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "IX",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "PSY17991",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Schempp
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• Rachel Sevy
• Leaf Bodhi Sexton, PHARM.D.
• Seyedeh Sima Shafiei, NMD
• Shah Doshi Dental Corporation
• Hetal Shah

• Clinical Psychologist in Livermore, CA
• Providers in Livermore, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.