Healthcare Provider Details

I. General information

NPI: 1063553873
Provider Name (Legal Business Name): CARA JANE ZEISLOFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 ASHBY AVE
BERKELEY CA
94705-1884
US

IV. Provider business mailing address

22 RANDWICK AVE
OAKLAND CA
94611-5724
US

V. Phone/Fax

Practice location:
  • Phone: 510-594-4331
  • Fax:
Mailing address:
  • Phone: 415-652-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 21892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: