1710570379 NPI number — TWO TREE COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION

Table of content: MR. JOSEPH KEVIN ROBERTS L.M.F.T. (NPI 1568408136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710570379 NPI number — TWO TREE COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWO TREE COUNSELING LICENSED CLINICAL SOCIAL WORKER CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1710570379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 BAYVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94610-4034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-332-9585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 BELLEVUE AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94610-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-545-2076
Provider Business Practice Location Address Fax Number:
510-768-8658
Provider Enumeration Date:
02/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JAY
Authorized Official Middle Name:
ELI
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
510-545-2076

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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