Healthcare Provider Details

I. General information

NPI: 1588444582
Provider Name (Legal Business Name): SASHA STAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 SHATTUCK AVE STE 210
BERKELEY CA
94704-2076
US

IV. Provider business mailing address

1438 MILVIA ST
BERKELEY CA
94709-1917
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-7475
  • Fax:
Mailing address:
  • Phone: 646-678-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number134728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: