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NPI Code Detail

MEDICARE: JONI K TEAGUE L.C.S.W.

MEDICARE: JONI K TEAGUE L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker14547CA

General Provider Information

NPI Number : 1528407830
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONI K TEAGUE L.C.S.W.
Provider Business Mailing Address
First Line : 3075 ADELINE ST STE 100
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2579
Country : US
Telephone Number : 510-984-1656
Fax Number :
Provider Business Practice Location Address
First Line : 3075 ADELINE ST STE 100
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2579
Country : US
Telephone Number : 510-984-1656
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2013
Last Update Date : 03/06/2014

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