Healthcare Provider Details

I. General information

NPI: 1063778264
Provider Name (Legal Business Name): HAGIKAH VICTORIA BIRDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 ADDISON ST
BERKELEY CA
94704-1141
US

IV. Provider business mailing address

415 PERKINS ST APT 11
OAKLAND CA
94610-4717
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-0999
  • Fax:
Mailing address:
  • Phone: 559-885-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: