Healthcare Provider Details

I. General information

NPI: 1710513247
Provider Name (Legal Business Name): MIA GAJDOSIK LCSW, MPH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATEMEH ADLPARVAR LCSW, MPH, MS

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

IV. Provider business mailing address

3021 TELEGRAPH AVE STE C
BERKELEY CA
94705-2072
US

V. Phone/Fax

Practice location:
  • Phone: 781-439-7132
  • Fax:
Mailing address:
  • Phone: 781-439-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127940
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: