Healthcare Provider Details

I. General information

NPI: 1215125901
Provider Name (Legal Business Name): MELVIN L. ESCOBAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST STE 201
BERKELEY CA
94705-1147
US

IV. Provider business mailing address

PO BOX 11487
OAKLAND CA
94611-0487
US

V. Phone/Fax

Practice location:
  • Phone: 510-788-0783
  • Fax:
Mailing address:
  • Phone: 510-788-0783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: