Avrille Birnbaum, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

31005 Issued in CA

Practice address

1019 47TH St Uppr Unit
Emeryville, CA 94608-3315

Phone

(510) 593-8942

NPI assigned

Jun 18, 2019

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

• Ms. Avrille Polack Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 19, 2020.

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1336709641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 47TH ST UPPR UNIT",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946083315",
            "telephone_number": "510-593-8942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 47TH ST UPPR UNIT",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946083315",
            "telephone_number": "510-593-8942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRNBAUM",
        "first_name": "AVRILLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "31005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AVRILLE",
            "last_name": "POLACK",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ja Mes Tecora Rose Belcher, BT
• Troy Benfield, D.C.
• Turshika Bennett
• Susan Beyer Bertelsen, P.A.-C.
• Brianna Bilotta
• Emily Hunter Birnbaum, FNP
• Michelle Black
• Will Richard Blackmon III, PA-C
• Beranah Azela Blaylock
• Janika Boguszewski Rodriguez, ASW

• All providers in Emeryville, CA
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.