Healthcare Provider Details

I. General information

NPI: 1770281057
Provider Name (Legal Business Name): ARIANNA VAEWSORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 63RD ST
OAKLAND CA
94609-1218
US

IV. Provider business mailing address

680 63RD ST
OAKLAND CA
94609-1218
US

V. Phone/Fax

Practice location:
  • Phone: 650-804-8524
  • Fax:
Mailing address:
  • Phone: 650-804-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW77550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: