| N/a | |
|
466 Crescent St #112 Oakland CA 94610-2662 | |
| (510) 332-3631 | |
| (866) 711-3422 |
| Full Name | N/a |
|---|---|
| Speciality | Social Worker |
| Location | 466 Crescent St, Oakland, California |
| Authorized Official Name and Position | Meredith L Caplin (CEO) |
| Authorized Official Contact | 5103323631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 466 Crescent St #112 Oakland CA 94610-2662 Ph: (510) 332-3631 | N/a 466 Crescent St #112 Oakland CA 94610-2662 Ph: (510) 332-3631 |
| NPI Number | 1194030999 |
|---|---|
| Provider Enumeration Date | 08/17/2010 |
| Last Update Date | 12/29/2015 |
| Medicare PECOS PAC ID | 7012105570 |
|---|---|
| Medicare Enrollment ID | O20101228000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194030999 | NPI | - | NPPES |
| Provider Name | Shawnessy P Odell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174765697 PECOS PAC ID: 4486783685 Enrollment ID: I20100526000879 |
| Provider Name | Janet I Hazen-wycoff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700177615 PECOS PAC ID: 0446514293 Enrollment ID: I20180503001436 |
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