| |
2484 Shattuck Ave 210 Berkeley CA 94704-2076 | |
(925) 927-2000 | |
(510) 704-7494 |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 2484 Shattuck Ave, Berkeley, California |
Authorized Official Name and Position | Allyson Mariko Holmes-knight (SR. DIRECTOR OF CLINICAL SERVICES) |
Authorized Official Contact | 9256447552 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2484 Shattuck Ave Suite 210 Berkeley CA 94706-2076 Ph: (925) 927-2000 | 2484 Shattuck Ave 210 Berkeley CA 94704-2076 Ph: (925) 927-2000 |
NPI Number | 1043252661 |
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Provider Enumeration Date | 06/11/2006 |
Last Update Date | 09/16/2024 |
Certification Date | 09/16/2024 |
Medicare PECOS PAC ID | 0345291225 |
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Medicare Enrollment ID | O20071227000475 |
Identifier | Type | State | Issuer |
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1043252661 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | ZZZ15557Z (California) | Secondary |
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Karen M Lottman |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1457464224 PECOS PAC ID: 0749231629 Enrollment ID: I20050208000845 |
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