Healthcare Provider Details

I. General information

NPI: 1275741167
Provider Name (Legal Business Name): ALTAF A BHIMJI L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 BONITA AVE FL 2
BERKELEY CA
94704-1014
US

IV. Provider business mailing address

PO BOX 27508
OAKLAND CA
94602-0508
US

V. Phone/Fax

Practice location:
  • Phone: 510-480-7671
  • Fax:
Mailing address:
  • Phone: 510-480-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW21486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: