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NPI Code Detail

MEDICARE: THEODORA MAY BONSALL

MEDICARE: THEODORA MAY BONSALL
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
1101YM0800XMental Health Counselor111855CA
2104100000XSocial Worker111855CA
3101Y00000XCounselor
4104100000XSocial Worker
5171M00000XCase Manager/Care Coordinator
61041C0700XClinical Social Worker135965CA
7390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1598278251
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORA MAY BONSALL
Provider Business Mailing Address
First Line : 1727 MARTIN LUTHER KING JR WAY STE 109
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1358
Country : US
Telephone Number : 916-949-9059
Fax Number :
Provider Business Practice Location Address
First Line : 3200 ADELINE ST
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2407
Country : US
Telephone Number : 510-601-0203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2017
Last Update Date : 12/16/2025

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Directions to “ THEODORA MAY BONSALL ” Practice Location

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