Healthcare Provider Details

I. General information

NPI: 1861935876
Provider Name (Legal Business Name): ABIGAIL ALLEN LANIEL ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax: 510-848-4445
Mailing address:
  • Phone: 510-848-1112
  • Fax: 510-848-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW118396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: