1891121836 NPI number — MS. AMELIA GARAHAN AVIRETT MSED

Table of content: MS. AMELIA GARAHAN AVIRETT MSED (NPI 1891121836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891121836 NPI number — MS. AMELIA GARAHAN AVIRETT MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVIRETT
Provider First Name:
AMELIA
Provider Middle Name:
GARAHAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEONARD
Provider Other First Name:
AMELIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PPSC-S2 SCHOOL PSYCH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1891121836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1918 UNIVERSITY AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94704-3264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-841-1262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 ARLINGTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LEANDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94578-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-317-1444
Provider Business Practice Location Address Fax Number:
510-481-1605
Provider Enumeration Date:
09/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  120021244 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)