Healthcare Provider Details

I. General information

NPI: 1538089974
Provider Name (Legal Business Name): IRINA NEYMARK SCHOOL COUNSELOR PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41717 PALM AVE
FREMONT CA
94539-4722
US

IV. Provider business mailing address

41717 PALM AVE
FREMONT CA
94539-4722
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163993
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number260137801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: