| Doctor Name: | DR. JOAN JERSEY PONATH |
| NPI Number: | 1003059593 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY11005 |
| Business Practice Address: | 1515 Clay St Fl 10 Oakland, CA - 946121499 |
| Business Phone Number: | 5106224789 |
| Business Fax Number: | 5106221834 |
| Mailing Address: | 1515 Clay St Fl 10, OAKLAND |
| State: | CA |
| Postal Code: | 946121499 |
| Phone Number: | 5106224789 |
| Fax Number: | 5106221834 |
| NPI Enumeration Date: | 04/13/2009 |
| NPI Last Update Date: | 04/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | PSY11005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |