Healthcare Provider Details

I. General information

NPI: 1801088364
Provider Name (Legal Business Name): SHARON HAWKINS LEYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 UNIVERSITY AVE
BERKELEY CA
94703-1514
US

IV. Provider business mailing address

1744 UNIVERSITY AVE
BERKELEY CA
94703-1514
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-9867
  • Fax: 510-848-1456
Mailing address:
  • Phone: 510-704-9867
  • Fax: 510-848-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: