Provider Demographics
NPI:1053777896
Name:TUCHMAN, SHENDL
Entity type:Individual
Prefix:DR
First Name:SHENDL
Middle Name:
Last Name:TUCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1900
Mailing Address - Country:US
Mailing Address - Phone:510-595-5525
Mailing Address - Fax:510-496-2712
Practice Address - Street 1:3120 TELEGRAPH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1900
Practice Address - Country:US
Practice Address - Phone:510-595-5525
Practice Address - Fax:510-496-2712
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19856103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist