Healthcare Provider Details

I. General information

NPI: 1760516793
Provider Name (Legal Business Name): FRED FINCH YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 35TH AVE
OAKLAND CA
94601-3124
US

IV. Provider business mailing address

3800 COOLIDGE AVE
OAKLAND CA
94602-3311
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-0282
  • Fax:
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-488-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA L TORTORELLI
Title or Position: PROJECT MANAGER
Credential:
Phone: 510-872-2116