Healthcare Provider Details

I. General information

NPI: 1821135740
Provider Name (Legal Business Name): JODY A. MASTROIANNI-ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODY ALLEN LCSW

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 SHATTUCK AVE UNIT 9358
BERKELEY CA
94709-9019
US

IV. Provider business mailing address

1521 SHATTUCK AVE UNIT 9358
BERKELEY CA
94709-9019
US

V. Phone/Fax

Practice location:
  • Phone: 213-709-4267
  • Fax:
Mailing address:
  • Phone: 213-709-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077945-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW71463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: