Healthcare Provider Details

I. General information

NPI: 1932391620
Provider Name (Legal Business Name): ILENE J YASEMSKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 CARLETON ST
BERKELEY CA
94704-3225
US

IV. Provider business mailing address

2232 CARLETON ST
BERKELEY CA
94704-3225
US

V. Phone/Fax

Practice location:
  • Phone: 510-297-4068
  • Fax: 510-527-0376
Mailing address:
  • Phone: 510-297-4068
  • Fax: 510-527-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 11210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: