Healthcare Provider Details

I. General information

NPI: 1780476531
Provider Name (Legal Business Name): LUCY ANNE BLEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 COLBY ST STE 221
BERKELEY CA
94705-2056
US

IV. Provider business mailing address

3010 COLBY ST STE 221
BERKELEY CA
94705-2056
US

V. Phone/Fax

Practice location:
  • Phone: 844-763-3560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: