Active NPI
Tonya Diane Petty
- School Psychologist
- Oakland, CA
National Provider Identifier
1972775765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 140206821
- Practice address
- 1011 Union St
Oakland, CA 94607-2236 - Phone
- (510) 879-5003
- NPI assigned
- Apr 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 140206821 | CA | Primary |
| Counselor | 101Y00000X |
Addresses
Primary practice location
1011 Union St
Oakland, CA 94607-2236
Mailing address
1011 Union St
Oakland, CA 94607-2236
Phone (510) 879-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140206821 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724198400000",
"number": "1972775765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 UNION ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946072236",
"telephone_number": "510-879-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 UNION ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946072236",
"telephone_number": "510-879-5003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "TONYA",
"middle_name": "DIANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-01",
"last_updated": "2024-08-21",
"certification_date": "2024-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "140206821",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.