1366794521 NPI number — OAKLAND UNIFIED SCHOOL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366794521 NPI number — OAKLAND UNIFIED SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKLAND UNIFIED SCHOOL DISTRICT
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:
6
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366794521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2850 WEST ST
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:
94608-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-874-3710
Provider Business Mailing Address Fax Number:
510-874-3707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2369 84TH AVENUE
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:
94605-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-879-0131
Provider Business Practice Location Address Fax Number:
510-879-0133
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
REIS
Authorized Official First Name:
GENEVIEVE
Authorized Official Middle Name:
SARAH HIGGINS
Authorized Official Title or Position:
CLINICAL SUPERVISOR
Authorized Official Telephone Number:
510-874-3710

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  LCSW 21739 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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