Healthcare Provider Details

I. General information

NPI: 1992923221
Provider Name (Legal Business Name): ANN MARTIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 55TH ST
EMERYVILLE CA
94608-2609
US

IV. Provider business mailing address

1375 55TH ST
EMERYVILLE CA
94608-2609
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-7880
  • Fax: 510-655-3379
Mailing address:
  • Phone: 510-655-7880
  • Fax: 510-655-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140000152
License Number StateCA

VIII. Authorized Official

Name: DR. HASSE LEONARD-PAGEL
Title or Position: DIRECTOR OF CLINICAL PROGRAMS
Credential: PHD
Phone: 510-655-7880