Healthcare Provider Details

I. General information

NPI: 1689799520
Provider Name (Legal Business Name): CITY OF BERKELEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 MARTIN LUTHER KING JR WAY
BERKELEY CA
94704-3238
US

IV. Provider business mailing address

3282 ADELINE ST
BERKELEY CA
94703-2439
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-5290
  • Fax: 510-596-9299
Mailing address:
  • Phone: 510-981-5280
  • Fax: 510-596-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YVETTE KATUALA
Title or Position: MENTAL HEALTH ASSISTANT MANAGER
Credential: MFT
Phone: 510-981-7654