Healthcare Provider Details

I. General information

NPI: 1780199885
Provider Name (Legal Business Name): BRIAHN BARIYA BADELLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 EIGHTH ST
BERKELEY CA
94710-2026
US

IV. Provider business mailing address

484 LAKE PARK AVE # 471
OAKLAND CA
94610-2730
US

V. Phone/Fax

Practice location:
  • Phone: 510-313-3858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: